Short-term surgical outcomes for colon adenocarcinoma: Racial-Ethnic comparisons in a universal access health system

Background: Access to care has been identified as a contributor to racial-ethnic differences in treatment receipt and survival of colon cancer in the U.S. Less is known about racial-ethnic differences in aspects and outcomes of colon cancer surgery and whether access to care plays a role. We aimed to study colon cancer surgery and short-term postoperative outcomes in the Military Health System (MHS), which provides access to care regardless of patient characteristics. Methods: We used the MilCanEpi database to identify patients aged 18 or older who were diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 and received colectomy as treatment. Outcomes included positive surgical margins, inadequate lymphadenectomy (<12 nodes examined), 30-day complications (any; general or gastrointestinal), and 30-day hospital readmissions. Multivariable Poisson regression models estimated the adjusted risk ratios (ARRs) and 95 % confidence intervals (CIs) in association with race-ethnicity for each outcome. Results: The study included 157 Asian or Pacific Islander, 258 non-Hispanic Black, 111 Hispanic, and 1131 non-Hispanic White patients. Overall, the risk of measured outcomes did not differ significantly for racial-ethnic minority groups compared to non-Hispanic White (ARRs and their 95 % CIs included 1.00). By complication type, Hispanic patients had significantly lower risk of bowel obstruction (ARR = 0.55, 95 % CI = 0.32, 0.96) compared to non-Hispanic White patients, with no other statistically significant racial-ethnic differences. Conclusions: In the universal access MHS, there were no overall significant racial-ethnic differences in surgical aspects or experience of 30-day outcomes of colectomy for non-metastatic colon cancer.