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Racial Disparity in 30-Day Morbidity and Mortality After Surgery for Ovarian Cancer
  1. Haider Mahdi, MD*,
  2. Amelia Jernigan, MD*,
  3. David Lockhart, BA,
  4. Mehdi Moslemi-Kebria, MD* and
  5. Peter G. Rose, MD*
  1. *Gynecologic Oncology Division, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH; and
  2. Department of Biostatistics, University of Washington, Seattle, WA.
  1. Address correspondence and reprint requests to Haider Mahdi, MD, Ob/Gyn and Women’s Health Institute, 9500 Euclid Ave, Cleveland, OH 44195. E-mail: mahdih6281{at}gmail.com.

Abstract

Background The improved survival observed in recent years for women with ovarian cancer (OC) has not been realized among African American (AA) compared with white (W) women. The contribution of immediate postoperative morbidity and mortality to this survival disparity remains unclear. This study aims to examine disparities in postoperative 30-day morbidity and mortality between AA and W women with OC.

Materials and Methods Patients with OC were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2005 to 2011. African American and subgroups were studied. Multivariable logistic regression models were performed.

Results Of 1649 women, 1510 (92%) were W and 139 (8%) were AA. The rate of 30-day postoperative complications and mortality among the entire cohort were 30% and 2%, respectively. No differences in postoperative complications were noted between AA and W women (33% vs 30%, P = 0.47) including surgical (29% vs 26%, P = 0.40) and nonsurgical (10% vs 9%, P = 0.75) complications. The mean length of hospital stay was longer in AA women, but there was no difference in surgical re-exploration and operative time. No difference in 30-day mortality was found between AA and W women (3% vs 2%, P = 0.45). African Americans were younger and more likely to be obese, have diabetes, hypertension, preoperative weight loss, higher serum creatinine level greater than or equal to 2 mg/dL, hypoalbuminemia, and anemia. After adjusting for surgical complexity and associated comorbidities, AA race was not an independent predictor of 30-day postoperative complications (odds ratio, 0.99; 95% confidence interval [CI], 0.65–1.5; P = 0.96) or mortality (odds ratio, 0.89; 95% confidence interval, 0.25–2.43; P = 0.83).

Conclusions African American race was not an independent predictor of poor 30-day outcomes. Interestingly, AAs with OC are underrepresented in quality-seeking hospitals. Efforts to minimize this racial disparity should target optimization of comorbidities and improving access to high-volume centers for AA women.

  • Race
  • Surgery
  • Ovarian cancer
  • Perioperative outcome
  • African American
  • White

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Footnotes

  • The authors declare no conflicts of interest.

  • Additional contributions: For this study, the linked American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used. The interpretation and reporting of these data are the sole responsibility of the authors. We acknowledge the efforts of the American College of Surgeons NSQIP for the creation of the NSQIP database.

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