Racial Disparities in Perioperative Outcomes for Patients With Head and Neck Cancer.

Abstract

Objective: To characterize the perioperative complications after ablative and reconstructive surgery in patients with head and neck cancer (HNC) based on race.

Methods: We conducted a retrospective study of the 2015-2020 National Surgical Quality Improvement Program Database. We compared the perioperative outcomes between White, Asian, Black, Native Hawaiian or Pacific Islander, and American Indian or Alaskan Native patients with bivariate analysis. Multivariate logistic regression assessed the independent association of race with perioperative complications.

Results: Black patients experienced longer surgeries (aβ, 43; 95% CI, 33, 53), longer hospital stays (aβ, 1.6 [95% CI, 1.1-2.1]), and were less likely to be discharged home (aOR, 0.64; [95% CI, 0.54, 0.76]). Black patients also had higher major complications risk (aOR, 1.38; [95% CI, 1.13-1.67]) with the most common being reintubation/ventilation (Black, 4.4% vs. White 2.7%; p = 0.003) and sepsis/septic shock (Black, 3.4% vs. White 1.8%; p = < 0.001). Black patients had higher reoperation rates (aOR, 1.33; [95% CI, 1.12-1.56]) with incision and drainage of abscess and hematoma, exploration of postoperative hemorrhage, thrombosis or infection, or surgical debridement being the top reasons for reoperation. Concordantly, they were at higher risk of postoperative transfusion (Black, 18%; White, 7.2%; p = < 0.001) and wound dehiscence (Black, 4.1%; White, 2.1%; p = < 0.001).

Conclusion: There is evidence of racial disparities in HNC surgery perioperatively. Black patients face an increased risk of major complications, reoperation, extended hospital stay, and non-home discharge. Developing a comprehensive surgical database with more social determinants of health variables and using a socioecological framework of health can help us identify contributors to these disparities and design high-leverage solutions.