Racial Disparities in 30‐day Readmissions after Surgery for Head and Neck Cancer

• Published in: The Laryngoscope 2024-03, Vol.134 (3), p.1282-1287
• Main Authors: Huang, Alice E, Shih, Jonathan J., Sunwoo, John B., Pollom, Erqi, Taparra, Kekoa
• Format: Article
• Language: English
• Subjects: Head & neck cancer; head and neck cancer; head and neck surgery; Native Hawaiian; Pacific Islander; postoperative readmission; racial disparities; Surgery
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.30997

Background Native Hawaiians and other Pacific Islanders (NHPI) patients with head and neck cancer are often aggregated with Asian individuals despite evidence of heterogeneous health outcomes and mortality. The aim of this study was to determine the association of race with unplanned 30‐day hospital readmission rate after head and neck surgery across the five federally recognized racial categories. Methods This retrospective cohort study used a national hospital‐based database and included patients ≥18 years old with diagnostically confirmed, nonmetastatic head and neck cancer of any subsite treated surgically between 2004 and 2017. The primary endpoint was unplanned readmission within 30 days of discharge after primary surgery. Results A total of 365,834 patients were included who were predominantly White (87%), treated at academic cancer centers (47%), lower income (63%), with early‐stage disease (60%), and with thyroid (47%) or oral cavity (23%) cancers. Median follow‐up duration was 47 months. Of the 10,717 (3%) readmissions, 5,845 (1.6%) were unplanned. Adjusted for confounders and compared with White patients, NHPI patients had the highest likelihood of unplanned (aOR 2.07, 95%CI 1.16–3.40, p = 0.008) readmissions. Within the NHPI group, patients with lower income (aOR 4.27, 95%CI 1.28–20.4, p = 0.035) and those residing in an urban or rural area (aOR 7.42, 95%CI 1.14–49.5, p = 0.034) were more likely to be readmitted. Conclusions NHPI patients with head and neck cancers experience significantly higher 30‐day readmissions following definitive surgical treatment. These results highlight the importance of racial disaggregation in clinical studies. Level of Evidence 4 Laryngoscope, 134:1282–1287, 2024 In this retrospective cohort study that included 365,834 adult patients with the most common head and neck cancers, Native Hawaiians and other Pacific Islanders (NHPI) patients had the highest risk of unplanned 30‐day readmissions after oncologic surgery compared with White patients, a trend not observed with the other federally recognized racial groups. This disparity highlights the importance of disaggregating NHPI race in clinical studies.