E135: Black-White Racial Inequalities in Quality Indicators in Colon Cancer Surgery: a retrospective cohort study of the National Surgical Quality Improvement Program.

Quality indicators (QI) are used to monitor healthcare quality. Currently, QIs are reported for entire groups of patients, without distinction by patients’ characteristics. If actions to improve care are based on metrics that do not consider patients’ characteristics, they may not benefit all patients. We compared the achievement of QIs between Black and White patients for colon cancer surgery.

Methods:

Black and White adults undergoing inpatient surgery for colon cancer were identified in the NSQIP registry (2016-2021). The primary exposure was race, divided as Black vs. White. The primary outcome was achievement of colon-specific QIs: adequate lymph node harvest (> 12 nodes), no anastomotic leak, no prolonged ileus. Each QI was examined individually and as a composite outcome (3 out 3 QIs achieved). Logistic regression analysis examined the association between race and outcomes, adjusting for potential confounders. Analyses were stratified by elective vs emergency surgery. The role stage at diagnosis was considered on the causal pathway and explored separately with an interaction between race and stage.

Results:

Of 50,034 patients, 13.1% (n=6,577) were Black and 75.4% (n=37,737) underwent elective surgery. Black patients were more likely to have comorbidities and node positive or metastatic cancer. After adjusting for age, sex, body mass index, bleeding disorders, diabetes, dialysis, congestive heart failure, chronic obstructive pulmonary disease, pre-op hematocrit, immunosuppression, functional status, and operation year, Black patients had lower odds of adequate nodal harvest (odds ratio- OR 0.86; 95% confidence interval- CI 0.75-0.99), higher odds of prolonged ileus (OR 1.41; 95%CI 1.28-1.55), and lower odds of achieving all QIs (OR 0.85l; 95%CI 0.79-0.91), compared to White patients, for elective surgery. Similar findings were observed for emergency surgery, with adjusted ORs of 0.77 (95%CI 0.63-0.94) for adequate nodal harvest, 1.26 (95%CI 1.12-1.43) for prolonged ileus, and 0.89 (95%CI 0.80-0.99) for achieving all QIs for Black compared to White patients. No association was identified with anastomotic leak. No significant interaction between stage and race was observed.

Conclusions:

QIs for colon cancer were achieved less often for Black patients compared to White patients. This information highlights inequities within QIs and supports the capture and reporting of QIs stratified by race. If this approach is not taken, differences in QIs may result in adverse outcomes for racialized patients.