Short-term surgical outcomes for colon adenocarcinoma: Racial-Ethnic comparisons in a universal access health system.

BACKGROUND

Access to care has been identified as a contributor to racial-ethnic differences in treatment receipt and survival of colon cancer in the U.S. Less is known about racial-ethnic differences in aspects and outcomes of colon cancer surgery and whether access to care plays a role. We aimed to study colon cancer surgery and short-term postoperative outcomes in the Military Health System (MHS), which provides access to care regardless of patient characteristics.

METHODS

We used the MilCanEpi database to identify patients aged 18 or older who were diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 and received colectomy as treatment. Outcomes included positive surgical margins, inadequate lymphadenectomy (<12 nodes examined), 30-day complications (any; general or gastrointestinal), and 30-day hospital readmissions. Multivariable Poisson regression models estimated the adjusted risk ratios (ARRs) and 95 % confidence intervals (CIs) in association with race-ethnicity for each outcome.

RESULTS

The study included 157 Asian or Pacific Islander, 258 non-Hispanic Black, 111 Hispanic, and 1131 non-Hispanic White patients. Overall, the risk of measured outcomes did not differ significantly for racial-ethnic minority groups compared to non-Hispanic White (ARRs and their 95 % CIs included 1.00). By complication type, Hispanic patients had significantly lower risk of bowel obstruction (ARR = 0.55, 95 % CI = 0.32, 0.96) compared to non-Hispanic White patients, with no other statistically significant racial-ethnic differences.

CONCLUSIONS

In the universal access MHS, there were no overall significant racial-ethnic differences in surgical aspects or experience of 30-day outcomes of colectomy for non-metastatic colon cancer.