Sook Y Chan1, Pasithorn A Suwanabol2, Rachelle N Damle3, Jennifer S Davids3, Paul R Sturrock3, W Brian Sweeney3, Justin A Maykel3, Karim Alavi3. 1. Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Suite 201, Worcester, MA, 01605, USA. sookchan06@gmail.com. 2. Division of Colon and Rectal Surgery, Department of Surgery, University of Michigan, 2124 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. 3. Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Suite 201, Worcester, MA, 01605, USA.
Abstract
BACKGROUND: There is a paucity of data demonstrating the effect race and insurance status have on postoperative outcomes for patients with rectal cancer. We evaluated factors impacting short-term outcomes following rectal cancer surgery. DESIGN: Patients who underwent surgery for rectal cancer using the University Health System Consortium database from 2011 to 2012 were studied. Univariate and multivariable analyses were used to identify patient related risk factors for 30-day outcomes after proctectomy: complication rate, 30-day readmission, ICU stay, and length of hospital stay (LOS). RESULTS: A total of 9272 proctectomies were identified in this cohort. After adjustment for potential confounders, black patients were more likely to have 30-day readmissions (OR 1.51, 95 % CI 1.26-1.81), ICU stays (OR 1.25, 95 % CI 1.03-1.51), and longer LOS (+1.67 days, 95 % CI 1.21-2.13) when compared to whites. Compared to those with private insurance, patients with public or military insurance or who were self-pay had a higher likelihood of having postoperative complications. CONCLUSIONS: In patients who undergo elective proctectomy for rectal cancer, non-white and non-privately insured status are associated with significantly worse short-term outcomes. Further studies are needed to determine the implications with respect to receipt of adjuvant therapy and survival.
BACKGROUND: There is a paucity of data demonstrating the effect race and insurance status have on postoperative outcomes for patients with rectal cancer. We evaluated factors impacting short-term outcomes following rectal cancer surgery. DESIGN:Patients who underwent surgery for rectal cancer using the University Health System Consortium database from 2011 to 2012 were studied. Univariate and multivariable analyses were used to identify patient related risk factors for 30-day outcomes after proctectomy: complication rate, 30-day readmission, ICU stay, and length of hospital stay (LOS). RESULTS: A total of 9272 proctectomies were identified in this cohort. After adjustment for potential confounders, black patients were more likely to have 30-day readmissions (OR 1.51, 95 % CI 1.26-1.81), ICU stays (OR 1.25, 95 % CI 1.03-1.51), and longer LOS (+1.67 days, 95 % CI 1.21-2.13) when compared to whites. Compared to those with private insurance, patients with public or military insurance or who were self-pay had a higher likelihood of having postoperative complications. CONCLUSIONS: In patients who undergo elective proctectomy for rectal cancer, non-white and non-privately insured status are associated with significantly worse short-term outcomes. Further studies are needed to determine the implications with respect to receipt of adjuvant therapy and survival.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Praful Ravi; Akshay Sood; Marianne Schmid; Firas Abdollah; Jesse D Sammon; Maxine Sun; Dane E Klett; Briony Varda; James O Peabody; Mani Menon; Adam S Kibel; Paul L Nguyen; Quoc-Dien Trinh Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: R G Roetzheim; N Pal; C Tennant; L Voti; J Z Ayanian; A Schwabe; J P Krischer Journal: J Natl Cancer Inst Date: 1999-08-18 Impact factor: 13.506
Authors: Rachelle N Damle; Christopher W Macomber; Julie M Flahive; Jennifer S Davids; W Brian Sweeney; Paul R Sturrock; Justin A Maykel; Heena P Santry; Karim Alavi Journal: J Am Coll Surg Date: 2014-03-12 Impact factor: 6.113
Authors: Helen M Parsons; Todd M Tuttle; Karen M Kuntz; James W Begun; Patricia M McGovern; Beth A Virnig Journal: J Am Coll Surg Date: 2012-06-08 Impact factor: 6.113
Authors: Jose Delgado; Elizabeth A Jacobs; Daniel T Lackland; Denis A Evans; Carlos F Mendes de Leon Journal: J Gerontol A Biol Sci Med Sci Date: 2012-04-10 Impact factor: 6.053
Authors: Sophia Y Chen; Miloslawa Stem; Susan L Gearhart; Bashar Safar; Sandy H Fang; Nilofer S Azad; Adrian G Murphy; Amol K Narang; Christopher L Wolfgang; Jonathan E Efron Journal: World J Surg Date: 2019-10 Impact factor: 3.352
Authors: Eric J Charles; J Hunter Mehaffey; Robert B Hawkins; Clifford E Fonner; Leora T Yarboro; Mohammed A Quader; Andy C Kiser; Jeffrey B Rich; Alan M Speir; Irving L Kron; Margaret C Tracci; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2019-01-22 Impact factor: 4.330