Does Race Impact Complication Rates after Pulmonary Lobectomy for Patients with Lung Cancer?
Yahya Alwatari, Michel J. Sabra, Jad Khoraki, Dawit Ayalew, Luke G. Wolfe, Anthony D. Cassano, Rachit D. Shah
VCU Health, Richmond, VA, USA
OBJECTIVE: Racial disparity in surgical access and post-operative outcomes after pulmonary lobectomy continues to be a concern and target for improvement; however, evidence of independent impact of race on complications is lacking. Aim was to investigate the impact of race on surgical outcomes after lobectomy for lung cancer and estimate the distribution of race groups among the expected resectable lung cancer cases using a large national database.
METHODS: Patients who underwent lobectomy for lung cancer between 2005 and 2016 were identified from the ACS-NSQIP. Preoperative characteristics and postoperative outcomes were compared between races in all patients and in propensity-matched cohorts, controlling for pertinent risk factors. Distribution of each race in the ACS-NSQIP database was calculated relative to the estimated number of patients withresectable lung cancer using national official data.RESULTS: 10,202 patients (age 67.6±9.7, 46.7% male, 86.4% white) underwent non-emergent lobectomy (46.8% thoracoscopic). Black patients had higher rates of baseline risk factors. In propensity-scorematched cohorts of Whites, Blacks and Hispanics/Asians (n=498 each), postoperatively, backs had higher rates of prolonged intubation and longer hospital stay while Whites had a higher rate of pneumonia. Race was independently associated with these adverse outcomes on multivariate analysis.
CONCLUSIONS: In a large national-level database, and after controlling for risk factors, Black patients had higher rates of several postoperative complications while White patients were more likely to develop pneumonia. There was lower than expected representation of Black and Hispanic surgical patients. Race was an independent factor associated with extended length of stay, prolonged intubation and pneumonia.
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