Racial disparities in the morbidity of radical cystectomy in the United States.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 304-304
Author(s):  
Tudor Borza ◽  
Chen Chen Feng ◽  
Jeffrey Leow ◽  
Benjamin I. Chung ◽  
Steven L. Chang
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Racial Disparities ◽  
Radical Cystectomy ◽  
Major Complication ◽  
The United States ◽  
Study Cohort ◽  
Complication Rates ◽  
Major Complications ◽  
Hispanic Patients

304 Background: Racial disparities in the management of bladder cancer have been previously reported. However, limited data exists on inequalities in the morbidity of radical cystectomy. We performed a contemporary population-based analysis to examine the association between race and surgical complications among patients undergoing radical cystectomy. Methods: We analyzed the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US. We identified patients who underwent radical cystectomy between 2003 and 2010 based on ICD-9 code (57.71). Primary outcome measure was 90-day major complication rates, defined as Clavien Classification System Grade 3-5, derived from ICD-9 codes. Multivariable logistic regression models were developed adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates to evaluate 90-day major complication for all patients (Model 1), patients ≥65 years (Model 2), and Medicare only patients (Model 3). Results: Our study cohort included 50,175 patients. The majority of patients were Caucasion (76%), men (83.5%), with Medicare (64.2%). Major complication rates were 16% for Caucasions, 17% for African American, 24% for Hispanics, and 16% for Other. Compared to Caucasians, the odds ratio (OR) of major complications for Hispanics was 1.9 (p=0.03) and 2.6 (p<0.0001) in Models 1 and 2, and 1.7 (p=0.1) for Model 3. None of the other racial groups had significantly different odds of major complications compared with Caucasians. Conclusions: In the United States, Hispanic patients are the least likely to undergo radical cystectomy but have the highest rate of major complication following surgery. Our analysis shows that this disparity is uniquely absent among Hispanic patients with Medicare suggesting that barriers to healthcare may underlie the observed phenomenon. Therefore, the worse outcomes for Hispanic patients with bladder cancer may be secondary to challenges in accessing medical treatment at earlier stages of disease arising from language differences and non-U.S. citizenship status.

scholarly journals Perioperative Outcomes of Different Surgical Methods Among Bladder Cancer Patients Undergoing Radical Cystectomy With Neobladder Urinary Diversion

2021 ◽  
Vol 19 (4) ◽  
pp. 261-270
Author(s):  
Hak Ju Kim ◽  
Changhee Ye ◽  
Jin Hyuck Kim ◽  
Hwanik Kim ◽  
Sangchul Lee ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Major Complication ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Major Complications ◽  
Surgical Methods ◽  
Significant Factors

Purpose: To compare perioperative outcomes according to surgical methods among bladder cancer patients who underwent radical cystectomy (RC) with neobladder urinary diversion.Materials and Methods: Between June 2007 and January 2020, 89 bladder cancer patients who received RC with neobladder urinary diversion were enrolled in this study. Patients were stratified into surgical methods – (1) open RC with neobladder (ONB) reconstruction, (2) robotassisted RC (RARC) with extracorporeal neobladder (ECNB) reconstruction, and (3) RARC with intracorporeal neobladder (ICNB) reconstruction. Perioperative outcomes were compared among the 3 groups, with major complications defined according to Clavien-Dindo grades III–V within 90 days. Logistic regression analysis was performed to identify significant factors for postoperative complications.Results: Of 89 patients, 28 (31%) had ONB, 31 (35%) had ECNB, and 30 (34%) had ICNB. The median operative time was 471 minutes, and the ICNB group (424.5 minutes) was significantly less than ONB (444.5 minutes) and ECNB groups (542.9 minutes) (p=0.001). Transfusion rate was also significantly less in the ICNB group (13%) (p=0.001). Complications were recorded in 67 patients (75%) and major complications in 22 of all patients (25%). The major complication rate was significantly less in ICNB (13.4%) than in ONB (25%) and ECNB (35%) (p=0.003). Multivariate analysis showed surgical methods (ICNB) (odds ratio [OR], 0.709; p=0.003) and age (OR, 1.150; p=0.001) were significant factors related to occurrence of major postoperative complications.Conclusions: RARC with ICNB reduces postoperative complications compared to ONB and ECNB.

Determining the optimal timing for radical cystectomy after neoadjuvant chemotherapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 339-339
Author(s):  
Chinedu O. Mmeje ◽  
Cooper Benson ◽  
Graciela M. Nogueras-Gonzalez ◽  
Isuru Sampath Jayaratna ◽  
Neema Navai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Major Complication ◽  
Complication Rates ◽  
Surgical Time ◽  
Node Metastasis ◽  
Major Complications

339 Background: We present the largest series reviewing complications and pathologic outcomes following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), to determine whether the interval between chemotherapy and surgery (ICS) affects 90-day post-operative morbidity and lymph node metastasis. Methods: We analyzed 338 patients treated with NAC followed by RC from January 1995 through December 2013. The association of ICS with 90-day surgical morbidity, incidence of major complication, 90-day readmission, and lymph node metastasis was determined. Generalized linear models were used to determine potential predictors of each endpoint. Patients were stratified into four groups by ICS days (18 – 42; 43 – 64; 64 – 85; > 85). Complications were classified using the Clavien system. Results: The overall morbidity of the cohort was 59%, with 66% being minor, and 34% being major complications. The median ICS was 46 days (18 – 199 days). There was no difference in the overall morbidity, readmission, or major complication rates among the four groups. Patients with an ICT > 85 days had the highest incidence of lymph node metastasis (40%), though this was not found to be significant (p = 0.1). On multivariate analysis including predictors of perioperative morbidity, extravesical (pT3 – 4) disease (OR = 1.97; p = 0.01) was an independent predictor of overall morbidity, while age at cystectomy (OR = 1.05; p = 0.004), and surgical time ≥ 7 hrs (OR = 2.87; p = 0.001) were independent predictors of major complications. Only surgical time ≥ 7 hrs (OR = 2.24; p = 0.006) was found to be a predictor of readmission. In a separate multivariate analysis that included risk factors for pathological node positivity, the predictors for lymph node metastasis included variant histology (OR = 2.06; p = 0.026) and extravesical disease (OR = 2.76; p = 0.002). Patients with an ICT > 85 days had a higher risk of node metastasis though this was not significant. Conclusions: Patients can undergo RC anytime between 2.5 – 12 weeks after NAC with no difference in risk of surgical complications or nodal metastasis.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

scholarly journals In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

2019 ◽  
Vol 102 (3) ◽  
pp. 284-292 ◽  
Author(s):  
Christer Groeben ◽  
Rainer Koch ◽  
Martin Baunacke ◽  
Angelika Borkowetz ◽  
Manfred P. Wirth ◽  
...  
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
The United States ◽  
Hospital Outcomes ◽  
National Trends

Assessing trends in urinary diversion after radical cystectomy for bladder cancer in the United States

2019 ◽  
Vol 37 (3) ◽  
pp. 180.e1-180.e9 ◽  
Author(s):  
Michael Lin-Brande ◽  
Azadeh Nazemi ◽  
Shane M. Pearce ◽  
Eli R. Thompson ◽  
Akbar N. Ashrafi ◽  
...  
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
The United States

scholarly journals MP01-04 ONCOLOGIC AND PERIOPERATIVE OUTCOMES OF “CYTOREDUCTIVE” RADICAL CYSTECTOMY FOR PATIENTS WITH METASTATIC BLADDER CANCER IN THE UNITED STATES

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Francisco Gelpi-Hammerschmidt ◽  
Jeffrey Leow ◽  
Dayron Rodriguez ◽  
Ilker Tinay ◽  
Christopher Allard ◽  
...  
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
The United States ◽  
Perioperative Outcomes ◽  
Metastatic Bladder Cancer

Americans Misperceive Racial Disparities in Economic Mobility

2021 ◽  
pp. 014616722110241
Author(s):  
Shai Davidai ◽  
Jesse Walker
Keyword(s):  
United States ◽  
Racial Disparities ◽  
American Dream ◽  
Black Americans ◽  
The United States ◽  
Economic Mobility ◽  
Systemic Racism ◽  
Economic Disparities ◽  
Lay Beliefs ◽  
Socioeconomic System

What do people know about racial disparities in “The American Dream”? Across six studies ( N = 1,761), we find that American participants consistently underestimate the Black–White disparity in economic mobility, believing that poor Black Americans are significantly more likely to move up the economic ladder than they actually are. We find that misperceptions about economic mobility are common among both White and Black respondents, and that this undue optimism about the prospect of mobility for Black Americans results from a narrow focus on the progress toward equality that has already been made. Consequently, making economic racial disparities salient, or merely reflecting on the unique hardships that Black Americans face in the United States, calibrates beliefs about economic mobility. We discuss the importance of these findings for understanding lay beliefs about the socioeconomic system, the denial of systemic racism in society, and support for policies aimed at reducing racial economic disparities.

scholarly journals Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 671
Author(s):  
Dylan T. Wolff ◽  
Thomas F. Monaghan ◽  
Danielle J. Gordon ◽  
Kyle P. Michelson ◽  
Tashzna Jones ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Bladder Cancer ◽  
Kidney Cancer ◽  
The United States ◽  
Coverage Rate ◽  
National Cancer Database ◽  
Genitourinary Cancer ◽  
Coverage Rates ◽  
Capture Rates

Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.

scholarly journals Are There Racial Disparities in Psychotropic Drug Use and Expenditures in a Nationally Representative Sample of Men in the United States? Evidence From the Medical Expenditure Panel Survey

2013 ◽  
Vol 8 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Geraldine Pierre ◽  
Roland J. Thorpe ◽  
Gniesha Y. Dinwiddie ◽  
Darrell J. Gaskin
Keyword(s):  
United States ◽  
Drug Use ◽  
Racial Disparities ◽  
Psychotropic Drug ◽  
Medical Expenditure Panel Survey ◽  
The United States ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Psychotropic Drug Use ◽  
Nationally Representative

This article sought to determine whether racial disparities exist in psychotropic drug use and expenditures in a nationally representative sample of men in the United States. Data were extracted from the 2000-2009 Medical Expenditure Panel Survey, a longitudinal survey that covers the U.S. civilian noninstitutionalized population. Full-Year Consolidated, Medical Conditions, and Prescribed Medicines data files were merged across 10 years of data. The sample of interest was limited to adult males aged 18 to 64 years, who reported their race as White, Black, Hispanic, or Asian. This study employed a pooled cross-sectional design and a two-part probit generalized linear model for analyses. Minority men reported a lower probability of psychotropic drug use (Black = −4.3%, 95% confidence interval [CI] = [−5.5, −3.0]; Hispanic = −3.8%, 95% CI = [−5.1, −2.6]; Asian = −4.5%, 95% CI = [−6.2, −2.7]) compared with White men. After controlling for demographic, socioeconomic, and health status variables, there were no statistically significant race differences in drug expenditures. Consistent with previous literature, racial and ethnic disparities in the use of psychotropic drugs present problems of access to mental health care and services.

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