Non-White Patients With CRC Have Increased Odds of Emergent Resection

Increased odds of having an emergent colorectal cancer (CRC) resection and other major adverse events were found to be associated with non-White race, according to a study published in Surgery Open Science. These disparities have proved to be present for nearly a decade.

Mortality from CRC has decreased in the US but racial disparities in incidence have continued, with Black patients having a 20% higher incidence of CRC compared with White patients. Emergent surgery has been used as a way to illustrate the manifestation of delayed treatment, which is especially true in CRC where progression of the disease is slower. This study aimed to assess the association between race and the need for emergency surgery in a 10-year span.

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The National Inpatient Sample data from 2011 to 2020 were used for this study, which provided accurate data for 97% of hospitalizations in the United States. Patients included were those 18 years or older who had a diagnosis of colon or rectal cancer and were having either a rectal resection or a colectomy. Data including age, sex, race, admission type, hospital region, and primary payer were collected for all patients. Comorbidities were also assessed. Hospitals were split into 3 groups of low volume (less than 40 cases), medium volume (40 to 130 cases), and high volume (more than 130 cases) based on their yearly volume. Cost-to-charge ratios were used to calculate hospitalization costs and adjusted for inflation to 2020.

There were an estimated 722,736 patients who had a resection for CRC during the time frame. A total of 74.6% were White, 11.2% were Black, 7.9% were Hispanic, and 6.3% were categorized as other race/ethnicity. Patients who were not White were younger (Black and Hispanic, 64 years vs White, 70 years). Black and Hispanic patients also more frequently had Medicaid compared with White patients (13.0% and 15.3% vs 4.7%, respectively).

A total of 67.6% of surgeries were elective and 32.4% were emergent. The total of emergent operations decreased from 33.7% in 2011 to 32.8% in 2020. Patients with an emergent surgery were more often older (71 vs 67 years) and Black (13.6% vs 10.1%) compared with elective surgery patients. Patients with an emergent surgery were also less commonly privately insured (22.6% vs 34.8%).

Increased odds of emergent surgeries were found in Black (adjusted OR [aOR], 1.38; 95% CI, 1.33-1.44), Hispanic (aOR, 1.45; 95% CI, 1.38-1.53), and other (aOR, 1.25; 95% CI, 1.18-1.32) patients compared with White patients. The proportion of non-White patients was 5% higher in emergent vs elective surgeries during the study period (29.1% vs 24.1% in 2020). Emergent admission was also associated with Medicaid (aOR, 2.01; 95% CI, 1.91-2.11) and uninsured patients (aOR, 3.52; 95% CI, 3.25-3.82) when compared with those on private insurance.

Greater rates of mortality were found in emergent patients compared with elective patients (4.1% vs 0.9%), which extended to rates of complications (14.6% vs 4.4%). When adjusting for risks, emergent patients were associated with a 3-fold increase in the odds of mortality and infectious, respiratory, and renal complications.

There were some limitations to this study. Time of cancer diagnosis, cancer staging, anatomic or physiologic complexity of the surgery, and indication for emergent operation were not included in the database. Previous screenings for CRC were not included. Clinical and financial end points could be assessed only at the time of admission and not for any readmissions or reoperations. Individual complications were heterogeneous. This study used International Classification of Diseases codes, which could be influenced by the provider.

The researchers concluded that patients who identified as non-White had increased odds of emergent CRC resection and other adverse events, with all of these disparities lasting throughout the decade. Timely screening for CRC and oncologic assessment prior to an operation can help in reducing the amount of emergent surgeries in this population.

Reference

Ng AP, Cho NY, Kim S, et al. National analysis of racial disparities in emergent surgery for colorectal cancer. Surg Open Sci. Published online January 24, 2024. doi:10.1016/j.sopen.2024.01.013