Racial, Socioeconomic Disparities Affect Access to Thoracic Surgeons for Esophagectomy

Health disparities regarding race, socioeconomic status, and rural location decrease access to treatment from a thoracic surgeon for an esophagectomy, according to study results published in Diseases of the Esophagus.

Researchers used the Premier Healthcare Database (PHD) to analyze disparities in access to thoracic surgeons for patients undergoing esophagectomy.

Patients were included in the study if they were at least 18 years of age and underwent elective esophagectomy for esophageal or gastric cardia cancer, Barrett esophagus, or achalasia. These diagnoses were determined with ICD-10 codes. The researchers studied admissions between the fourth quarter of 2015 and the fourth quarter of 2019. Patients were excluded if they had an unknown discharge status, if their admission was nonelective, if they did not achieve inpatient status, or if the specialty of the surgeon performing their esophagectomy was unknown.

The primary outcome was whether a thoracic surgery specialist performed the esophagectomy. Secondary outcomes were hospital length-of-stay and in-hospital mortality. A total of 960 patients met the inclusion criteria and were included in the study. A total of 43.5% (n=1,696) had been treated by a thoracic surgeon, while nonthoracic specialists treated 56.5% (n=2,199). The proportion of esophagectomies performed by thoracic surgeons increased from 42.3% to 47.4% from 2015 to 2019.

Researchers discovered certain demographic differences between the 2 groups. Patients who were uninsured vs insured (2.9% vs 6.2%, P =.03), identified as “Other” race (1.7% vs 8.0%, P =.004), received care in a rural hospital setting vs an urban setting (3.1% vs 13.3%, P =.02), or had metastatic cancer (13.0% vs 19.6%, P =.02) were significantly less likely to have their esophagectomy performed by a thoracic specialist. White patients were significantly more likely to receive care from a thoracic provider (91.2% vs 85.7%, P =.004).

Study limitations include limited details in the PDH about clinical staging, adjuvant treatments, or intraoperative surgical data to compare the 2 groups. Second, the researchers indicated that the disparities noted in the paper may actually be underestimating the true values, as patients without access to a specialist of any kind may not have been offered surgical care by any physician in the first place. Last, they note that individual differences between surgeons in terms of patient volume could contribute to differing outcomes.

“Factors associated with a decreased likelihood of esophagectomy patients receiving care from a thoracic provider included Nonwhite race, lower socioeconomic status, and receipt of care in a rural hospital setting,” the study authors wrote. “As studies have shown improved outcomes with provider subspecialization for complex surgical procedures such as esophagectomy, efforts to address these disparities and provide appropriate access to thoracic surgeons is warranted for best practices to improve patient outcomes.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.