Effect of Race/Ethnicity on In-hospital Outcomes After Radical Cystectomy.

Objective: Previously, African American race/ethnicity predisposed to higher rate of adverse in-hospital outcomes after radical cystectomy (RC). We tested whether this association applies to contemporary RC patients.

Methods: Patients were identified within the National Inpatient Sample (NIS 2000-2019). Multivariable logistic and Poisson regression models were fitted.

Results: Of 19,370 RC patients, 1,089 (5.6%) were African American, while 18,281 (94.4%) were Caucasian. Relative to Caucasians, African Americans were younger (median age 66 vs. 70 years; p < 0.001), more frequently female (33.8 vs. 18.5%; p < 0.001) and more frequently in the lowest income quartile (46.8 vs. 18.6%; p < 0.001). Relative to Caucasians, after RC, African Americans exhibited higher rates of postoperative complications (61.3 vs. 58.3%; multivariable odds ratio [MOR] 1.2; p = 0.009). Specifically, African Americans exhibited higher rates of blood transfusions (30.2 vs. 24.1%; MOR 1.3; p < 0.001), gastrointestinal (26.7 vs. 24.1%; MOR 1.2; p = 0.003), and infectious (6.2 vs. 4.2%; MOR 1.5; p = 0.001) complications, as well as deep vein thrombosis (3.1 vs. 1.7%; MOR 1.9; p < 0.001). Additionally, after RC, African Americans exhibited higher rates of critical care therapy use (CCT; 13.9 vs. 12.2%; MOR 1.3; p = 0.002) and in-hospital mortality (2.8 vs. 1.7%; MOR 1.8; p = 0.002). Finally, African Americans exhibited higher rates of length of stay ≥ 75th percentile (40.9 vs. 31.2%; MOR 1.6; p < 0.001).

Conclusions: In contemporary RC patients, African American race/ethnicity predisposes to less favorable in-hospital outcomes, including higher in-hospital mortality and longer hospital stay. Unfortunately, these race/ethnicity disadvantages have not been improved upon relative to the previous report.