Disparities in Surgical Treatment of Resectable Pancreatic Adenocarcinoma at Minority Serving Hospitals.

Autor: Olecki EJ; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania. Electronic address: eolecki@pennstatehealth.psu.edu., Perez Holguin RA; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania., Mayhew MM; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania., Wong WG; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania., Vining CC; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Program for Liver, Pancreas & Foregut Tumors, Division of Surgical Oncology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania., Peng JS; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Program for Liver, Pancreas & Foregut Tumors, Division of Surgical Oncology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania., Shen C; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania., Dixon MEB; Department of Surgery, Rush University Medical College, Chicago, Illinois; Section of Hepatopancreatobiliary Surgery, Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Feb; Vol. 294, pp. 160-168. Date of Electronic Publication: 2023 Oct 26.
DOI: 10.1016/j.jss.2023.09.066
Abstrakt: Introduction: Minority serving hospitals (MSH) are those serving a disproportionally high number of minority patients. Previous research has demonstrated that treatment at MSH is associated with worse outcomes. We hypothesize that patients treated at MSH are less likely to undergo surgical resection of pancreatic adenocarcinoma compared to patients treated at non-MSH.
Methods: Patients with resectable pancreatic cancer were identified using the National Cancer Database. Institutions treating Black and Hispanic patients in the top decile were categorized as an MSH. Factors associated with the primary outcome of definitive surgical resection were evaluated using multivariable logistic regression. Univariate and multivariable survival analysis was performed.
Results: Of the 75,513 patients included in this study, 7.2% were treated at MSH. Patients treated at MSH were younger, more likely to be uninsured, and higher stage compared to those treated at non-MSH (P < 0.001). Patients treated at MSH underwent surgical resection at lower rates (MSH 40% versus non-MSH 44.5%, P < 0.001). On multivariable logistic regression, treatment at MSH was associated with decreased likelihood of undergoing definitive surgery (odds ratio 0.91, P = 0.006). Of those who underwent surgical resection, multivariable survival analysis revealed that treatment at an MSH was associated with increased morality (hazard ratio 1.12, P < 0.001).
Conclusions: Patients with resectable pancreatic adenocarcinoma treated at MSH are less likely to undergo surgical resection compared to those treated at non-MSH. Targeted interventions are needed to address the unique barriers facing MSH facilities in providing care to patients with pancreatic adenocarcinoma.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: