title: Racial disparity in 30-day morbidity and mortality after surgery for ovarian cancer.
abstract: BACKGROUND
  The improved survival observed in recent years for women with ovarian cancer (OC) has not been realized among African American (AA) compared with white (W) women. The contribution of immediate postoperative morbidity and mortality to this survival disparity remains unclear. This study aims to examine disparities in postoperative 30-day morbidity and mortality between AA and W women with OC.
  
  
  METHODS
  Patients with OC were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2005 to 2011. African American and subgroups were studied. Multivariable logistic regression models were performed.
  
  
  RESULTS
  Of 1649 women, 1510 (92%) were W and 139 (8%) were AA. The rate of 30-day postoperative complications and mortality among the entire cohort were 30% and 2%, respectively. No differences in postoperative complications were noted between AA and W women (33% vs 30%, P = 0.47) including surgical (29% vs 26%, P = 0.40) and nonsurgical (10% vs 9%, P = 0.75) complications. The mean length of hospital stay was longer in AA women, but there was no difference in surgical re-exploration and operative time. No difference in 30-day mortality was found between AA and W women (3% vs 2%, P = 0.45). African Americans were younger and more likely to be obese, have diabetes, hypertension, preoperative weight loss, higher serum creatinine level greater than or equal to 2 mg/dL, hypoalbuminemia, and anemia. After adjusting for surgical complexity and associated comorbidities, AA race was not an independent predictor of 30-day postoperative complications (odds ratio, 0.99; 95% confidence interval [CI], 0.65-1.5; P = 0.96) or mortality (odds ratio, 0.89; 95% confidence interval, 0.25-2.43; P = 0.83).
  
  
  CONCLUSIONS
  African American race was not an independent predictor of poor 30-day outcomes. Interestingly, AAs with OC are underrepresented in quality-seeking hospitals. Efforts to minimize this racial disparity should target optimization of comorbidities and improving access to high-volume centers for AA women.
authors.affiliation: *Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH; and †Department of Biostatistics, University of Washington, Seattle, WA.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.forename: Amelia
authors.initials: A
authors.lastname: Jernigan
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.forename: Mehdi
authors.initials: M
authors.lastname: Moslemi-Kebria
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*