Disparities in treatment of liver lesions: NSQIP analysis of how race affects oncologic management

Abstract

Objective: Racial disparities are associated with increased healthcare costs and suboptimal resource utilization. We sought to evaluate racial disparities in the therapeutic management of liver lesions. Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients presenting with a liver lesion who had surgical resection (SR) or an ablative procedure (AP). Univariable and multivariable analysis were performed to identify disparities in the treatment rendered. A regression model was constructed to evaluate demographic characteristics favoring AP. Results: Between 2005 and 2016, 8,706 patients were diagnosed with a liver lesion, 7,290 (84%) had SR and 1,416 (16%) had AP. Compared to SR, the AP cohort had a higher number of Native Americans (0.5% vs. 2%; p<0.001), Asians (12.8% vs. 15.5%; p=0.006), African-Americans (9.3% vs. 11.3%; p=0.02), and Hispanics (6.1% vs. 7.7%; p=0.02) but fewer Caucasians (61.7% vs. 55.3%; p<0.001). On multivariable analysis, minority race independently favored AP, with Native Americans demonstrating the highest odds (OR 4.3, 95% CI: 2.3-8.1), followed by Asians (1.3, 95% CI: 1.1-1.6) and African-Americans (1.3, 95% CI: 1.01-1.6). Conclusions: Racial disparities exist in the oncologic management of liver lesions, which could be partly responsible for the lower survival observed among ethnic minorities. These results identify possible opportunities to improve outcomes and healthcare costs associated with the treatment of liver lesions.

Keywords

• liver lesion
• tumor
• racial disparity
• nsqip
• management