Failure to rescue following colorectal cancer surgery at minority-serving hospitals: A National Inpatient Sample analysis.

Abstract

e23067 Background: Given persistent disparities in surgical outcomes, this study examines patient- and system-level factors associated with differences in failure-to-rescue (FTR) rates after colorectal cancer (CRC) surgery between minority-serving hospitals (MSHs) and non–minority-serving hospitals (non-MSHs). Methods: A retrospective cohort analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2022. FTR, defined as mortality following a complication among patients undergoing CRC surgery, was identified using ICD-10 diagnostic and procedural codes. MSHs were defined as hospitals in the top quintile for the proportion of Black or Hispanic patients treated. Univariate and multivariable regression analyses were performed to assess disparities in FTR between MSH and non-MSH cohorts. Results: Among 4,173,403 hospitalizations for CRC surgery, 25% occurred at MSHs. Patients treated at MSHs compared with non-MSHs were younger (mean age 57.2 vs. 61.1 years), male (49.0% vs. 46.6%), and non-Hispanic Black (23.5% vs. 8.0%) or Hispanic (28.0% vs. 6.1%). On univariate analysis comparing MSHs versus non-MSHs, FTR and inpatient mortality were higher at 1.9% vs 1.8% (OR 1.06; 95% CI, 1.02-1.11) and 2.0% vs 1.8% (OR 1.06; 95% CI, 1.02-1.10), respectively. On multivariable logistic regression, after adjustment for clinical and surgical factors, MSH status remained independently associated with increased odds of FTR (aOR 1.08; 95% CI, 1.03-1.14). Additionally, hospitalizations at MSHs were associated with longer length of stay (7.2 vs. 6.6 days) and higher total hospitalization costs ($114,799 vs. $93,208). Secondary complications occurred more frequently at MSHs, including shock (OR 1.15, p<0.001), cardiac arrest/CPR (OR 1.33, p<0.001), CVA (OR 1.22, p<0.001), DVT (OR 1.23, p<0.001), and relaparotomy (OR 1.41, p<0.0001). Conclusions: Patients admitted to MSHs experienced disproportionately higher complications, mortality, and FTR rates following CRC surgery compared to non-MSHs. Notwithstanding poorer clinical outcomes, MSHs had longer hospitalizations and higher costs. Taken together, this evidence emphasizes the need to address the disparities in surgical outcomes at MSHs. Understanding the patient and system-related factors that play a role in these differences is critical to facilitating earlier identification of complications, which may improve postoperative mortality and FTR.