Importance American Indians (AIs) have the poorest cancer survival rates
of any US ethnic group. Late diagnosis, poor access to specialty care,
and delays in therapy likely contribute to excess mortality. Surgery
plays a central role in therapy for solid organ cancer.
Objective To determine whether operative outcomes also contribute to poor
long-term survival among AI patients with cancer.
Design Population-based retrospective cohort study comparing patient-
and hospital-level factors and short-term operative outcomes for AI
and non-Hispanic white patients. Survey-weighted multivariate analyses
assessed the effect of AI ethnicity on hospital location, in-hospital
mortality, and prolonged length of stay.
Setting A 20% stratified sample of all US community hospitals.
Patients Patients undergoing oncologic resection for 1 of 20 malignant
neoplasms in the Nationwide Inpatient Sample from January 1, 1998,
through December 31, 2009.
Main Outcome Measure In-hospital mortality, length of stay, and hospital location
(rural vs urban).
Results Of 740 878 patients who met our inclusion criteria, 3048
were AIs. The AI patients were younger, more likely to undergo cancer
surgery at rural hospitals, and more likely to be admitted for nonelective
procedures and had more comorbidities than non-Hispanic white patients
of similar ages (all, P < .05).
The AI patients had comparable inpatient mortality and length of stay.
Conclusions and Relevance This investigation is the largest study of surgical outcomes
among AIs to date and the first to focus on cancer surgery. This relatively
young cohort does not experience poor outcomes after oncologic resection.
Future research should uncover other factors in the continuum of cancer
care that may contribute to the poor long-term survival of AI patients
with cancer, including delivery of perioperative therapies.