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Low socioeconomic status increased mortality after cancer surgery
Patients in the lowest quintile of socioeconomic status were more likely to experience major complications, failure to rescue and mortality after cancer surgery, according to results of a retrospective study.
Researchers used the Medicare Provider Analysis and Review File and Medicare Denominator File to identify 596,222 patients who underwent esophagectomy, pancreatectomy, partial or total gastrectomy, colectomy, lung resection or cystectomy for cancer between 2003 and 2007. Investigators used 2000 US Census data to evaluate socioeconomic status according to residence.
More patients in the lowest quintile of socioeconomic status than the highest quintile experienced postoperative complications (25.6% vs. 23.8%; P=.003) and mortality (10.2% vs. 7.7%; P=.0009).
The largest disparity between lowest and highest quintile of socioeconomic status was related to the rate of failure to rescue, defined as fatality after one or more major complication (26.7% vs. 23.2%; P=.007).
Hospitals with the largest proportion of patients with low socioeconomic status demonstrated higher rates of failure to rescue among all patients treated, regardless of their socioeconomic status.
Researchers also evaluated data according to surgery type. After adjustments for patient characteristics, failure to rescue was more likely to occur after pancreatectomy (OR=1.45; 95% CI, 1.21-1.73) and less likely after gastrectomy (OR=1.04; 95% CI, 0.95-1.14).
However, in analyses adjusted for patient characteristics and hospital effects, the difference in failure to rescue according to socioeconomic status was only statistically significant for colectomy (OR=1.07; 95% CI, 1.02-1.11).
“Although various hospital characteristics have been identified as potential contributors to successful rescue from complications, it is likely that some combination of hospital resources, attitudes and behaviors is what yields an environment most conducive to the timely recognition and effective management of complications,” the researchers wrote. “Future national hospital quality improvement initiatives can use these findings as evidence to support efforts to improve rescue rates in poorly performing hospitals, as part of a broad strategy directed toward effectively reducing socioeconomic disparities in cancer surgery mortality.”
Disclosure: Researchers report consultant roles with ArborMetrix Inc.
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