Abstract A003: Disparities in postoperative complications and 90-day unplanned readmission following surgery for head and neck cancer
Authors: Ramirez Ricardo J , Pipkorn Patrik , Mazul Angela L , Stwalley Dustin , Zevallos Jose P 
Published: September 2020

Head and neck cancer (HNC) is the eighth most common cancer in the United States with over 64,000 new cases and 14,000 deaths annually. Racial-ethnic and socioeconomic disparities have contributed to long-term mortality and overall worse oncologic outcomes in HNC patients. Despite robust research on differences in long-term morbidity and survival outcomes, there have been no studies comparing outcomes in the acute postoperative period. Our study aimed to determine whether racial-ethnic and socioeconomic status (SES) are risk factors for major complications occurring in the postoperative-inpatient setting following ablative surgery for HNC. A retrospective cohort study was performed using the State Inpatient Database from the state of New York from 2006-2015. Patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for HNC and an ICD-9-CM procedure code for ablative surgery present during the same admission were identified. Patients living outside of New York state, under the age of 18, and those with missing data were excluded. Exposures were race, SES and comorbidities. The primary outcome of interest was major perioperative complication, as defined by the Clavien-Dindo classification for surgical complications grades III-V. Minor complications (grades I-II) are ICD-9-CM codes for any unanticipated event, grade III for a subsequent intervention, grade IV for single- or multi-organ dysfunction, and grade V for death. Secondary outcomes were inpatient mortality and 90-day unplanned readmission. We used a multivariable logistic regression with an alpha of 0.01. We identified 23,066,146 available records. After applying inclusion/exclusion criteria, our final cohort consisted of 8,564 patients. White middle-aged males made up approximately two-thirds of the patient cohort. Black patients accounted for 10%, Hispanics 8%, Asians 4%, and other/multiracial 11% of included patients. Thirty-nine percent of patients had private insurance while 14% had Medicaid. The most common procedure was glossectomy (34%) and the most common diagnosis was oropharyngeal cancer (25%). Forty-one percent of patients experienced a surgical complication. Major complications accounted for 55% of all complications. There were 105 inpatient deaths for an inpatient mortality rate of 1%. On multivariable analysis, race was not associated with major complication while Medicaid payer status was predictive (aOR: 1.53, 99% CI: 1.20-1.79). Race and SES were not associated with inpatient mortality. Median household income below the second quartile was associate with increased risk of 90-day unplanned readmission (aOR: 1.28, 99%CI: 1.02-1.62). Despite prior studies showing racial-ethnic cancer disparities in long-term outcomes, race is not associated with differences in acute postoperative outcomes. Disadvantaged SES, however, is associated with increased risk of surgical complications grades III-V and 90-day unplanned readmission.

Citation Format: Ricardo J Ramirez, Patrik Pipkorn, Angela L Mazul, Dustin Stwalley, Jose P Zevallos. Disparities in postoperative complications and 90-day unplanned readmission following surgery for head and neck cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A003.