Cystectomy Morbidity Risk Highest in Hispanics

VANCOUVER—Americans of Hispanic origin are more likely to develop major complications after radical cystectomy than Caucasians, according to a study presented at the 33rd Congress of the Societé Internationale d'Urologie.

Using information from a large administrative database, researchers found a 23.5% rate of major complication within 90 days of surgery among Hispanic-Americans undergoing radical cystectomy compared with a 16.0% rate among whites and a 17.0% rate among African Americans. Compared with whites, Hispanics had an 88% increased odds of major post-cystectomy complications.

When the researchers analyzed data only from individuals aged 65 and older, they found that the increased major-complication risk for Hispanics remained statistically significant. When only Medicare beneficiaries were included in analyses, however, the difference lost its statistical significance. Therefore, the team members concluded that being older than 65 and being uninsured or under-insured (that is, not covered by Medicare) may account for at least part of the racial disparity.

“One critical limitation preventing us from further interpreting the dataset is that it lacks disease-specific information such as disease stage and grade,” observed lead investigator Chenchen Feng, MD, from Brigham and Women's Hospital in Boston. “We definitely have to find more detailed datasets to be able to do so.”

He and his team hypothesize that barriers to accessing care for Hispanics such as lack of proficiency in English and not having full immigrant status may underlie the phenomenon they observed.

Dr. Feng and his co-investigators used information from the Prospective Rx Comparative Database. It is administered in Charlotte, N.C., and is a repository for data from more than 600 non-federal hospitals across the U.S. They gathered information from patients who had a radical cystectomy from 2003 to 2010. The cohort, in weighted numbers, included 38,903 Caucasians, 2,343 African Americans, 875 Hispanics and 8,864 people from other races.

The groups all had significantly different characteristics. These ranged from a smaller proportion of individuals aged 75 and older in the Hispanic and African-American groups compared to the “other” races; a larger proportion of females among African Americans compared with all of the other race groups; and a larger proportion of Hispanics receiving their surgery in hospitals with more than 600 beds.

A multivariate analysis looking only at patients aged 65 and older showed a significant 82% increased risk for major complications among Hispanics versus whites.

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