Racial variation in the quality of surgical care for prostate cancer.
OBJECTIVE
Difference in the quality of care may contribute to the less optimal prostate cancer treatment outcomes among black men compared with white men. We determined whether a racial quality of care gap exists in surgical care for prostate cancer, as evidenced by racial variation in the use of high volume surgeons and facilities, and in the quality of certain outcome measures of care.


METHODS
We performed cross-sectional and cohort analyses of administrative data from the Healthcare Cost and Utilization Project all-payer State Inpatient Databases, encompassing all nonfederal hospitals in Florida, Maryland and New York State from 1996 to 2007. Included in analysis were men 18 years old or older with a diagnosis of prostate cancer who underwent radical prostatectomy. We compared the use of surgeons and/or hospitals in the top quartile of annual volume for this procedure, inpatient blood transfusion, complications, mortality and length of stay between black and white patients.


RESULTS
Of 105,972 patients 81,112 (76.5%) were white, 14,006 (13.2%) were black, 6,999 (6.6%) were Hispanic and 3,855 (3.6%) were all other. In mixed effects multivariate models, black men had markedly lower use of high volume hospitals (OR 0.73, 95% CI 0.70-0.76) and surgeons (OR 0.67, 95% CI 0.64-0.70) compared to white men. Black men also had higher odds of blood transfusion (OR 1.08, 95% CI 1.01-1.14), longer length of stay (OR 1.07, 95% CI 1.06-1.07) and inpatient mortality (OR 1.73, 95% CI 1.02-2.92).


CONCLUSIONS
Using an all-payer data set, we identified concerning potential quality of care gaps between black and white men undergoing radical prostatectomy for prostate cancer.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA. dan.barocas@vanderbilt.edu
Daniel A
DA
Barocas
Darryl T
DT
Gray
Jay H
JH
Fowke
Nathaniel D
ND
Mercaldo
Jeffrey D
JD
Blume
Sam S
SS
Chang
Michael S
MS
Cookson
Joseph A
JA
Smith
David F
DF
Penson
D001741:Black or African American; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000601:surgery*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044465:White People