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Disparities in Surgical Oncologic Care

E156: Racial Disparities in Utilization of Minimally Invasive Surgery for Gastrointestinal Cancers

    ePoster Abstract Author(s)

  • Andrei Gurau, MD, MHS, MS (he/him/his)

    Research Fellow & Resident Physician
    Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Valley Health General Surgery Residency, The Valley Health Hospital System
    Baltimore, Maryland, United States

    • Submitter(s)

  • Andrei Gurau, MD, MHS, MS (he/him/his)

    Research Fellow & Resident Physician
    Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Valley Health General Surgery Residency, The Valley Health Hospital System
    Baltimore, Maryland, United States

    • Author(s)

  • Andrei Gurau, MD, MHS, MS (he/him/his)

    Research Fellow & Resident Physician
    Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Valley Health General Surgery Residency, The Valley Health Hospital System
    Baltimore, Maryland, United States

  • OM

    Olivia Monton, MD

    Research Fellow & Resident Physician
    Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Division of General Surgery, Department of Surgery, McMaster University, United States

  • Jonathan B. Greer, MD

    Assistant Professor of Surgery
    Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine
    Baltimore, Maryland, United States

  • Fabian M. Johnston, MD, MHS

    Associate Professor of Surgery
    Division of Gastrointestinal Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
    Baltimore, Maryland, United States

Introduction:

Racial disparities in utilization of minimally invasive surgery (MIS) across gastrointestinal (GI) cancers has not been well characterized. The objective of this study is to evaluate racial differences in use of MIS approaches (laparoscopic and robotic) compared to open operations for GI cancers.

Methods:

We performed a retrospective analysis of 841,053 patients with GI cancers in the National Cancer Database for 2010-2020. Multinomial multivariate logistic regression was used to evaluate the association between race and surgical approach (laparoscopic or robotic vs. open operation), adjusting for demographics, clinical characteristics, cancer location and stage, primary payor, income quartile, and medical center location and type.

Results:

Of the 841,053 patients, 98,635 (11.7%) of patients were Black, 34,206 (4.1%) were Asian, 3,019 (0.4%) were Native American, and 9,415 (1.1%) were classified as Other. The remainder 695,778 (82.7%) were White. Compared to White patients, the adjusted odds of laparoscopic compared to open resection were lower for Black patients (OR 0.97, 95% CI 0.95-0.98) but higher for Asian patients (OR 1.09, 1.06-1.12) and other races (OR 1.13, 1.08-1.19). Similarly, adjusted odds of robotic compared to open resection were lower for Black patients (OR 0.90, 0.87-0.92) but higher for Asian patients (OR 1.23, 1.19-1.28) and other races (OR 1.35, 1.27-1.45).

Conclusions:

Black patients have disproportionately lower utilization of MIS approaches for GI resections as compared to White patients. Efforts should be made to characterize and mitigate barriers to MIS to ensure equitable access to these procedures.

Learning Objectives:

  • list at least two racial groups that had differential utilization of minimally invasive surgery compared to open surgery in White patients for GI cancers.
  • accurately state the adjusted odds ratio for utilization of robotic surgery for at least one minority racial group compared to White patients.
  • summarize in one sentence the study's finding regarding differences in utilization of minimally invasive surgery between Black patients and White patients.