title: Racial Disparities in Postoperative Complications After Radical Nephrectomy: A Population-based Analysis.
abstract: OBJECTIVE
  To perform a population-based study that evaluates contemporary racial disparities in the morbidity profile of patients undergoing radical nephrectomy in the United States.
  
  
  METHODS
  Using the Premier hospital database (Premier Inc, Charlotte, NC), which collects data from over 600 nonfederal hospitals throughout the United States, we identified patients undergoing a total nephrectomy as their primary procedure and also had a concurrent diagnosis of a kidney mass or cancer from 2003 to 2010. The primary outcome was 90-day major complication rates, based on the Clavien classification system. Multivariate logistic regression models were performed, adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates.
  
  
  RESULTS
  The study population included 25,517 patients translating into a weighted sample of 185,135 radical nephrectomies. In a multivariate model including patient, hospital, and surgical characteristics, blacks were more commonly associated with a major complication (odds ratio, 2.1; P <.0001). When we incorporated Charlson comorbidity score into the model, the racial disparity in major complications was attenuated by 36% (odds ratio, 1.7; P <.0001). Adjusting for annual surgical volume in the multivariate model did not alter results.
  
  
  CONCLUSIONS
  Our contemporary evaluation of patients undergoing radical nephrectomy in the United States demonstrates that blacks are associated with a markedly elevated rate of major complications as compared to whites. This disparity is possibly a result of unequal access to routine health care.
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gelpi-Hammerschmidt
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA; La Sapienza School of Medicine, University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Del Giudice
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA.
authors.forename: Smita
authors.initials: S
authors.lastname: De
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Chou
authors.affiliation: Department of Urology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Kang Hyon
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA.
authors.forename: Leanne
authors.initials: L
authors.lastname: Almario
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: slchang@bics.bwh.harvard.edu.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People