Oncology - Bladder, Renal, Test
Introduction & Objective : Despite a common goal of providing excellent healthcare to people across the country regardless of race, gender, payment method, and geographic location there are still significant disparities in both access to care and outcomes.
A retrospective cross sectional analysis was performed using data from the National Inpatient Sample (NIS) from January 2001 to December 2013. Radical nephrectomy cases were identified by ICD-9 codes 55.5 for complete nephrectomy and 55.54 for bilateral nephrectomy. Partial nephrectomies were identified by the code 55.4. The ICD-9 code 17.42 was used to identify robotic-assisted laparoscopic cases; 54.21 and 54.51 were used to identify laparoscopic cases. Demographic data as well outcomes including length of hospital stay, cost, and mortality were compiled. Multivariable analyses included generalized linear models for continuous outcome measures (length of stay and total costs) and logistic regression models for binary outcomes (mortality). All statistical analyses were performed using STATA, version 12.1.
White patients represent a larger proportion of those undergoing robotic procedures in both the nephrectomy and partial nephrectomy cohort as compared to the total number of cases (Radical: 69.5% robotic vs. 59.6% all cases p<0.001, Partial: 68.2% robotic vs. 63.6% all cases p<0.001). In both cohorts the mean age of those undergoing surgery are substantially lower in minority populations (See Tables 1 and 2). Additionally, in a logistic regression the odds ratio for mortality was 2.3 for self-pay patients as compared to commercial insurance in the radical nephrectomy cohort, and 1.9 in the partial nephrectomy cohort (p<0.001 and p=0.229 respectively).
Conclusions : Unfortunately, statistically and likely clinically significant differences exist in the access to care and the outcomes for patients of different races, and insurance types.