Characterizing Short-Term Outcomes Following Surgery for Rectal Cancer: the Role of Race and Insurance Status

J Gastrointest Surg. 2016 Nov;20(11):1891-1898. doi: 10.1007/s11605-016-3241-9. Epub 2016 Aug 25.

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.

Keywords: Anal neoplasia; Colorectal.

MeSH terms

  • Aged
  • Black People / statistics & numerical data
  • Black or African American
  • Critical Care / economics
  • Critical Care / statistics & numerical data
  • Databases, Factual / statistics & numerical data
  • Digestive System Surgical Procedures / adverse effects*
  • Digestive System Surgical Procedures / economics
  • Digestive System Surgical Procedures / statistics & numerical data
  • Female
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / statistics & numerical data*
  • Intensive Care Units / economics
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology
  • Postoperative Complications / ethnology
  • Rectal Neoplasms / economics
  • Rectal Neoplasms / ethnology
  • Rectal Neoplasms / surgery*
  • Risk Factors
  • Treatment Outcome
  • United States / epidemiology
  • White People / statistics & numerical data