Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery

Niranjan J. Sathianathen, Stephanie L. Jarosek, Yunhua Fan, Suprita R. Krishna, Badrinath R. Konety

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22 Scopus citations


Introduction: Disparities in healthcare outcomes between races have been extensively described; however, studies fail to characterize the contribution of differences in distribution of covariates between groups and the impact of discrimination. This study aims to characterize the degree to which clinicodemographic factors and unmeasured confounders are contributing to any observed disparities between non-Hispanic white and black males on surgical outcomes after major urologic cancer surgery. Methods: Non-Hispanic white and black males undergoing radical cystectomy, nephrectomy, or prostatectomy for cancer in the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this analysis. The outcome of interest was Clavien III–V complications. Analysis was conducted in 2017 using the Peters–Belson method to compare the disparity in outcomes while adjusting for 13 important demographic and clinical characteristics. Results: Of the 15,693 cases included with complete data, 13.0% (n=2,040) were black. There was a significantly increased rate of unadjusted Clavien III and V complications between white versus black males for radical cystectomy (21.9% vs 10.1%, p=0.005); nephrectomy (6.4% vs 3.9%, p=0.028); and radical prostatectomy (2.3% vs 1.6%, p=0.046). Adjusting for differences in age, BMI, American Society of Anesthesiologists score, functional status, smoking history, and comorbidities including diabetes, chronic obstructive pulmonary disease, heart failure, renal failure, bleeding disorder, steroid use, unintentional weight loss, and hypertension between the groups could not explain the disparity in complications after radical cystectomy; the unexplained discrepancy was an absolute excess of 11.8% (p=0.01) in black males. There was an unexplained excess of complications in black males undergoing radical prostatectomy and nephrectomy but neither reached statistical significance. Conclusions: Black males undergoing radical cystectomy for cancer experienced higher complication rates than white males. Unexplained differences between the black and white males significantly contributed to the disparity in outcomes, which suggests that unmeasured factors, such as the quality of surgical or perioperative care, are playing a considerable role in the observed inequality. Supplement information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Original languageEnglish (US)
Pages (from-to)S14-S21
JournalAmerican journal of preventive medicine
Issue number5
StatePublished - Nov 2018

Bibliographical note

Funding Information:
Niranjan J. Sathianathen has received support from the Cloverfields Foundation and The Institute for Prostate and Urologic Cancers (University of Minnesota). No other financial disclosures were reported by the authors of this paper.

Funding Information:
Publication of this article was supported by a grant from the National Institute on Minority Health and Health Disparities, National Institutes of Health [grant number U54MD008620]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

Publisher Copyright:
© 2018 American Journal of Preventive Medicine


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