title: Racial disparity in the 30-day morbidity and mortality after surgery for endometrial cancer.
abstract: OBJECTIVE
  To examine postoperative 30-day morbidity and mortality in African American (AA) compared to white patients (W) with endometrial cancer (EC).
  
  
  METHODS
  Patients with EC were identified from the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011. AA and W subgroups were studied. Multivariable logistic regression models were performed.
  
  
  RESULTS
  Of 3248 patients, 2899 (89%) W and 349 (11%) AA were identified. AA were more likely to have diabetes, hypertension, ascites, neurologic morbidities, weight loss, non-independent functional status, higher ASA class, higher serum creatinine ≥ 2 mg/dl, hypoalbuminemia and anemia. Laparoscopic surgery was performed less frequently in AA than W (41.4% vs. 50.3%, p<0.001). AA had a significantly higher risk of postoperative complications than W (21% vs. 12%, p<0.001) including surgical (17% vs. 10%, p<0.001) and non-surgical complications (7% vs. 4%, p=0.022). Mean length of hospital stay and operative time were longer in AA than W but there was no difference in surgical re-exploration. In multivariable model after adjustment for confounders including surgical complexity and associated morbidities, AA race was not an independent predictor of "any postoperative complications" for both laparotomy group (OR 1.1, 95% CI 0.73-1.61, p=0.65) and laparoscopic group (OR 1.43, 95% CI 0.80-2.45, p=0.21). No difference in 30-day mortality was found between AA and W (1% vs. 1%, p=0.11).
  
  
  CONCLUSIONS
  AA patients with EC have more preoperative morbidities, postoperative complications and were less likely to undergo minimally invasive surgery. However, AA race was not an independent predictor of poor 30-day outcomes after controlling for other confounders.
authors.affiliation: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: mahdih6281@gmail.com.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.affiliation: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Moslemi-Kebria
authors.affiliation: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013997:Time Factors; D044465:White People
keywords: African American; Endometrial cancer; Morbidity and Mortality; Race; Surgery; White