title: Race-based disparities in loss of functional independence after hysterectomy for uterine cancer.
abstract: Racial disparities in uterine cancer-related outcomes have been reported. The goal of this study was to determine if race, pre-operative body mass index (BMI), and medical comorbidities are predictors of loss of functional independence after hysterectomy for uterine cancer.
  
  
  
  Loss of independence was defined as a change from pre-operative functional independence, to a post-operative requirement of discharge to a post-care facility, or death within the first 30 days following uterine cancer surgery. Demographic factors, comorbidities, BMI, intra-operative and post-operative outcomes, and discharge status were abstracted from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Statistical analyses included multivariable logistic regression and Wald tests for interaction.
  
  
  
  A total of 4005 patients had uterine cancer and were functionally independent pre-operatively. After adjusting for clinical features and comorbidities, Black women were not significantly more likely to lose functional independence than non-Black women. However, a significant interaction (OR = 1.17, p < 0.001) was found between race and BMI for loss of functional independence. Interaction plots revealed worsening functional outcomes for Black women with BMI >40 but not in non-Blacks.
  
  
  
  The interaction suggests a 17 % increased odds of losing independence for each unit of BMI difference for Black uterine cancer patients, or 170 % increased odds of losing independence for a 10-point increase in BMI, given a linear association. To reduce the likelihood of losing post-operative functional independence, Black, high-BMI patients with or at risk for uterine cancer may especially benefit from weight loss or interventions to optimize physical function.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ldean9@jhu.edu.
authors.forename: Lorraine T
authors.initials: LT
authors.lastname: Dean
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Xiaochen
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nawar
authors.initials: N
authors.lastname: Latif
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Giuntoli
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Lilie
authors.initials: L
authors.lastname: Lin
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Haggerty
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Shalowitz
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Stashwick
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Fiona
authors.initials: F
authors.lastname: Simpkins
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Burger
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Ko
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schmitz
mesh_terms: D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D044469:Racial Groups; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000208:ethnology / Q000601:surgery*
keywords: Functional dependence; Racial/ethnic disparities; Survivorship; Uterine cancer