Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer

Mulhern, Kayln C.; Wahl, Tyler S.; Goss, Lauren; Feng, Katey; Richman, Joshua S.; Chen, Herbert; Chu, Daniel I.

doi:10.1016/j.jss.2017.05.036

Cited by 16 publications

(4 citation statements)

References 20 publications

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“…We believe these discrepancies of calibration across different studies could be due to ethnic differences or may be a result of provider and healthcare system differences. Previously, Asian patients have been found to have better operative outcomes compared to other ethnic groups [22, 23], which may explain why NELA over‐predicts mortality in our study's predominantly Asian population. Future work could look into further validating the NELA risk score in Asian populations to see if further calibration to Asian patients is needed.…”

Section: Discussionmentioning

confidence: 79%

A Comparison of the P‐POSSUM and NELA Risk Score for Patients Undergoing Emergency Laparotomy in Singapore

et al. 2021

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Background (aims, hypotheses, or objectives) Emergency laparotomy (EL) is a high‐risk surgical procedure associated with considerable morbidity and mortality around the world. A reliable risk‐assessment tool that is specific to patients undergoing EL allows the early identification of high‐risk patients and enables appropriate healthcare resource allocation. The objective of this study was to compare the commonly used Portsmouth‐physiologic and operative severity score for the enumeration of mortality and morbidity (P‐POSSUM) with the recently developed National Emergency Laparotomy Audit (NELA) score in terms of their accuracy for identifying patients at increased risk of 30‐day mortality in a predominantly Asian population. Methods Physiological and operative data from a prospectively collected audit of adult patients undergoing EL in 2018 and 2019 across two tertiary hospitals in Singapore were used to retrospectively calculate both the P‐POSSUM and NELA scores for each patient encounter. This was then compared to actual mortality rates to determine each model's accuracy and precision. Results 830 patients were included in the study with a 30‐day mortality of 5.66%. The area under the receiver operating characteristics curve (AUROC) was similar for both the NELA (0.86, p < 0.001, 95% CI 0.81–0.91) and the P‐POSSUM models (0.84, p < 0.001, 95% CI 0.78–0.89). While the models over‐predicted mortality, overall O:E ratios showed that the NELA model performance was superior to that of P‐POSSUM (0.58 [95% CI 0.43–0.77] compared to 0.34 [95% CI 0.26–0.46]). Conclusion The NELA risk‐prediction model accurately predicts 30‐day mortality in this large cohort of patients undergoing EL and outperforms the current P‐POSSUM model. We recommend that the NELA score should replace the P‐POSSUM score as a model to distinguish between high‐ and low‐risk patients undergoing EL.

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Section: Discussionmentioning

confidence: 79%

A Comparison of the P‐POSSUM and NELA Risk Score for Patients Undergoing Emergency Laparotomy in Singapore

et al. 2021

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“…5 Generally, racial disparities in disease incidence and prevalence, mortality, burden, and health care outcomes have been well documented in a multitude of acute and long-term diseases including sepsis, 6 heart failure, 7 and cancer. 8,9 Racial and ethnic disparities in health care exist and have been shown to be associated with worse outcomes in many cases as reported by the comprehensive Institute of Medicine (IOM). 10 Although the growing prevalence and incidence rates of thyroid cancer are similar among races, except among Native Americans, there is evidence to suggest a significant survival difference among races at 5 years.…”

Section: Introductionmentioning

confidence: 99%

Gender and Racial Disparities in Survival After Surgery Among Papillary and Patients With Follicular Thyroid Cancer: A 45-Year Experience

Asban

Chung

Xie

et al. 2019

Clin Med Insights Endocrinol Diabetes

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Background: Demographic disparities have been described for survival after thyroid cancer surgery using national registries and databases. At the institution level, we hypothesized that assessing survival after thyroid cancer surgery in a long-term cohort with diverse gender and racial groups would reveal disparities in survival. Methods: We examined medical records of patients with papillary or follicular thyroid cancer undergoing thyroidectomy, lobectomy, and other surgical procedures from 1971 to 2016 at a tertiary referral center. We obtained information on demographics, cancer stage, procedure, and radioactive iodine (RAI). We measured survival using Kaplan-Meier estimates and Cox proportional hazards models. Results: A total of 1440 (91%) patients with papillary cancer and 144 (9%) patients with follicular thyroid cancer underwent total thyroidectomy (1297, 82%), lobectomy (261, 16.5%), and other surgical procedures (26, 1.5%). Most patients (1131, 71%) were woman, and 909 (57%) were older than 45 years. Race/ethnicity included 805 (51%) white, 161 (10%) African Americans, and 618 (39%) other race/ethnicities. Both 10- and 20-year survival rates in nonwhite males were worse compared with nonwhite females ( P < .0001). After controlling for age, cancer type, stage, surgical procedure, RAI, and year of surgery, nonwhite males had a higher mortality risk compared with nonwhite females ( P = .0376, confidence interval (CI): 1.03-2.43), white males ( P < .0001, CI: 1.88-6.54), and white females ( P < .0001, CI: 3.31-9.90). Conclusions: Our diverse cohort demonstrates significant gender and racial disparities in survival after thyroid cancer surgery. To improve health outcomes and reduce health disparities among nonwhite males, interventions and long-term care management should target potentially modifiable causes of worse outcomes in this group.

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“…11,26 There have been a variety of hypotheses proposed to explain this phenomenon, with a predominant one being that Asian patients historically experience a lower rate of comorbidities that are often associated with surgical complications. [27][28][29] One study examining racial disparities in care after colorectal surgery showed Asian Americans are more likely to have a BMI ,25, be nonsmoking, and have lower American Society of Anesthesiologists (ASA) scores of 1 or 2. 28 These demographic-wide characteristics have been corroborated by several studies.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29] One study examining racial disparities in care after colorectal surgery showed Asian Americans are more likely to have a BMI ,25, be nonsmoking, and have lower American Society of Anesthesiologists (ASA) scores of 1 or 2. 28 These demographic-wide characteristics have been corroborated by several studies. 27,29,30 Similarly, in our present analysis of patients undergoing orthopaedic surgery, Asian patients were noted to have markedly lower BMIs at an average of 19.25 kg/m 2 , as well as markedly lower rates of insulindependent diabetes and smoking history compared with other races.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis

Bergstein,

O'Sullivan,

Levy

et al. 2024

JAAOS Glob Res Rev

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Background: Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. Methods: The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. Results: Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. Conclusions: Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.

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Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer

Cited by 16 publications

References 20 publications

A Comparison of the P‐POSSUM and NELA Risk Score for Patients Undergoing Emergency Laparotomy in Singapore

A Comparison of the P‐POSSUM and NELA Risk Score for Patients Undergoing Emergency Laparotomy in Singapore

Gender and Racial Disparities in Survival After Surgery Among Papillary and Patients With Follicular Thyroid Cancer: A 45-Year Experience

Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis

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