Understanding Racial Differences in Lung Cancer Surgery Through a Statewide Quality Collaborative

• Published in: Annals of surgical oncology 2023, Vol.30 (1), p.517-526
• Main Authors: Bonner, Sidra N., He, Chang, Clark, Melissa, Adams, Kumari, Orelaru, Felix, Popoff, Andrew, Chang, Andrew, Wakeam, Elliot, Lagisetty, Kiran
• Format: Article
• Language: English
• Subjects: Collaboration; Humans; Inequality; Lung cancer; Lung Neoplasms - surgery; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Michigan; Mortality; Oncology; Patients; Racial differences; Retrospective Studies; Surgery; Surgical Oncology; Thoracic Oncology; Thoracic surgery; Thorax
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-022-12435-x

Background Persistent racial disparities in lung cancer incidence, treatment, and survival are well documented. Given the importance of surgical resection for lung cancer treatment, racial disparities in surgical quality were investigated using a statewide quality collaborative. Methods This retrospective study used data from the Michigan Society of Cardiothoracic Surgeons General Thoracic database, which includes data gathered for the Society of Thoracic Surgeons General Thoracic Surgery Database at 17 institutions in Michigan. Adult patients undergoing resection for lung cancer between 2015 and 2021 were included. Propensity score-weighting methodology was used to assess differences in surgical quality, including extent of resection, adequate lymph node evaluation, 30-day mortality, and 30-day readmission rate between white and black patients. Results The cohort included 5073 patients comprising 357 (7%) black and 4716 (93%) white patients. The black patients had significantly higher unadjusted rates of wedge resection than the white patients, but after propensity score-weighting for clinical factors, wedge resection did not differ from lobectomy (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.78–1.49; P = 0.67). The black patients had fewer lymph nodes collected (incidence rate ratio [IRR], 0.77; 95% CI, 0.73–0.81; P < 0.0001) and lymph node stations sampled (IRR, 0.89; 95% CI, 0.84–0.94; P < 0.0001). The black patients did not differ from the white patients in terms of mortality (OR, 0.65; 95% CI, 0.19–2.34; P = 0.55) or readmission (OR, 0.79; 95 % CI, 0.49–1.27; P = 0.32). The black patients had longer hospital stays (OR, 1.08; 95% CI, 1.02–1.14; P = 0.01). Conclusion In a statewide quality collaborative that included high-volume centers, black patients received a less extensive lymph node evaluation, with fewer non-anatomic wedge resections performed, and a more limited lymph node evaluation with lobectomy.