Decreased Use of Sphincter-Preserving Procedures among African-American Patients with Rectal Cancer
Elliot G Arsoniadis, MD, Yunhua Fan, PhD, Stephanie L Jarosek, Wolfgang B Gaertner, MD, Genevieve B Melton, MD, PhD, FACS, Robert D Madoff, MD, FACS, Mary R Kwaan, MD, MPH, FACS University of Minnesota, Minneapolis, MN
INTRODUCTION: Improved rectal cancer treatment has increased the use of anal sphincter-preserving procedures (SPP). It is unclear whether African-American (AA) patients are benefitting from SPP at rates similar to those of non-African American (non-AA) counterparts.
METHODS: We used the Nationwide Inpatient Sample for years 1998 to 2012 to compare AA and non-AA patients who had ICD-9 rectal cancer diagnosis codes and ICD-9 low anterior resection (LAR) or abdominoperineal resection (APR) procedure codes. We used a logistic regression model to adjust for age, sex, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs rural), teaching status, and rectal-resection procedure volume.
RESULTS: Our search identified 22,697 patients, 1,600 of whom identified as AA. After adjustment for age and sex, AA patients were less likely to undergo SPP compared with non-AA (odds ratio [OR] 0.71, 95% CI 0.64-0.78, p<0.0001). After further adjustment for Elixhauser comorbidity index, admission type, and hospital-specific factors, AA patients were still less likely to undergo SPP (OR 0.73, 95% CI 0.65-0.82, p<0.0001) (Table). Although the proportion of non-AA patients undergoing SPP increased during the study period (p¼0.03), this trend was not significant in AA patients (p¼0.18) (Table).
CONCLUSIONS: African-American patients with rectal cancer have lower rates of SPP compared with non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate reasons for this concerning difference. Eliminating racial disparities in rectal cancer treatment should continue as a priority for the surgical community.