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Head and Neck Surgery

(415) Racial Disparities in Outcomes After Major Head and Neck Surgery

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Ryan M. Kong, MD: No relevant relationships to disclose.
Jennifer J. Liang, MD: No relevant relationships to disclose.
Nira A. Goldstein: No relevant relationships to disclose.


Introduction: Understanding racial disparities in postoperative outcomes after major head and neck cancer surgery (MHNCS) is crucial in improving overall cancer survival; however, evidence of the independent impact of race on outcomes is lacking. This study aims to investigate the effect of race/ethnicity on surgical outcomes after major head and neck surgery using a large national database.

Methods: A retrospective cohort study was done querying the ACS-NSQIP database between 2014-2021. Patients undergoing MHNCS were grouped into five groups: White, Black, Hispanic, Asian, and Unknown/Non-Reported. Multivariable regression was used to analyze adverse outcomes between the groups after adjustment for age, sex, BMI, smoking status, ASA score, preoperative estimation of morbidity, and comorbidities.

Results: Out of 8372 patients, the group distributions were: White, 5702 (68.1%); Black, 507 (6.1%); Hispanic, 407 (4.9%); Asian, 336 (4.0%); Unknown/Not Reported, 1420 (17.0%). Multivariable regression showed Black patients compared to white patients had significantly increased odds ratios of overall (1.42 [1.12-1.81]; p=0.004), severe (1.69 [1.37-2.09]; p< 0.001), sepsis-related (1.96 [1.19-3.25]; p=0.009), and thromboembolic complications (2.32 [1.22-4.42]; p=0.010) as well as readmission (1.34 [1.00-1.79]; p=0.048). However, Hispanic patients had decreased odds of pulmonary (0.26 [0.10-0.72]; p=0.009) and severe complications (0.50 [0.35-0.72]; p< 0.001) as well as reoperation (0.50 [0.30-0.83]; p=0.007), while Asian patients had decreased odds of severe complications (0.66 [0.46-0.94]; p=0.020) and reoperation (0.39 [0.21-0.72]; p=0.003).

Conclusions: Significant racial disparities exist in complications following MHNCS, with a higher odds ratio of complications in blacks. However, minority populations are often underrepresented in the reporting of ACS-NSQIP data. Additional research is needed to identify those factors causing healthcare outcome disparities, which would help in enabling effective interventions and increased reporting of healthcare data from minority populations.