Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization, and to identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns.
We queried the New York Statewide Planning and Research Cooperative System (SPARCS) database (1995-2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white/black race and a valid New York State zip code were included (n=2895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality.
Black patients (n=361, 12.5%) were significantly (p<0.001) different than their white counterparts in the proportion of females, Medicaid, income distribution and privately insured individuals. Overall 55% patients utilized HVH; however, blacks were significantly less likely to use a HVH than whites (OR=0.18; 95%CI=0.14-0.24) even though 74.5% resided within 8.9 miles of one. Surgery performed at HVHs was associated with lower in-hospital mortality (OR=0.48; 95%CI=0.35-0.65); however, mortality remained higher for blacks (OR=2.04; 95%CI=1.65-3.30; propensity matched OR=2.45; 95%CI=1.5-4.03).
Black patients were less likely to undergo esophagectomy at a HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients' decision process and improve referral practices to ensure optimal care is provided across all segments of the population irrespective of race, insurance or income status.
This research output has an Altmetric Attention Score of 17. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 August 2018.
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