AHRQ Study Examines Quality of Bladder Cancer Surgery for Black and White Patients

A recent study published in the journal Cancer showed that, among nearly 17,000 patients undergoing cystectomy (bladder removal) for bladder cancer from 1996 through 2009, black patients received lower quality of care by some metrics than did white patients. The researchers found that blacks were treated more often by surgeons and hospitals that had performed fewer cystectomies, received fewer recommended related surgical procedures for their condition, and experienced more adverse outcomes than did whites. Even when black patients were treated by high-volume surgeons and hospitals, the researchers found that they still received fewer recommended related surgical procedures and had more adverse outcomes than did white patients. Findings were based on AHRQ Healthcare Cost and Utilization Project data, and the study was restricted to discharges from Florida, Maryland, and New York hospitals meeting specific AHRQ criteria for anticipated accuracy in coding of race/ethnicity. The study, titled “Racial Variation in the Quality of Surgical Care for Bladder Cancer,” was published online on December 11, 2013, and coauthors included AHRQ’s Darryl T. Gray, M.D.

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2013 Dec 11. doi: 10.1002/cncr.28520. [Epub ahead of print]

Racial variation in the quality of surgical care for bladder cancer.

Barocas DA1, Alvarez J, Koyama T, Anderson CB, Gray DT, Fowke JH, You C, Chang SS, Cookson MS, Smith JA Jr, Penson DF.

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Abstract

BACKGROUND:

Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BCa). Quality indicators in patients undergoing surgery for BCa include the use of high-volume surgeons and high-volume hospitals, and, when clinically indicated, receipt of pelvic lymphadenectomy, receipt of continent urinary diversion, and undergoing radical cystectomy instead of partial cystectomy. The authors compared these quality indicators as well as adverse perioperative outcomes in black patients and white patients with BCa.

METHODS:

The Healthcare Cost and Utilization Project State Inpatient Databases for New York, Florida, and Maryland (1996-2009) were used, because they consistently included race, surgeon, and hospital identifiers. Quality indicators were compared across racial groups using regression models adjusting for age, sex, Elixhauser comorbidity sum, insurance, state, and year of surgery, accounting for clustering within hospital.

RESULTS:

Black patients were treated more often by lower volume surgeons and hospitals, they had significantly lower receipt of pelvic lymphadenectomy and continent diversion, and they experienced higher rates of adverse outcomes compared with white patients. These associations remained significant for black patients who received treatment from surgeons and at hospitals in the top volume decile.

CONCLUSIONS:

Black patients with BCa had lower use of experienced providers and institutions for BCa surgery. In addition, the quality of care for black patients was lower than that for whites even if they received treatment in a high-volume setting. This gap in quality of care requires further investigation. Cancer 2013. © 2013 American Cancer Society.