The role of race in hepatectomy surgical approach and outcomes

Objective: Surgical approach for hepatectomy influences perioperative outcomes. This study sought to examine the role of race in intended surgical approach for hepatectomy. Methods: The National Surgical Quality Improvement Program Database identified African American (AA) and Caucasian patients undergoing hepatectomy in between January 1, 2014 and December 31, 2014. All other races were excluded. Demographic information, intended surgical approach, and short-term postoperative outcomes were compared. Results: All 2280 patients included in the study were AA (9.9%, n=225) or Caucasian (90.1%, n=2055). Minimally invasive hepatectomy (MIS) (p=0.621) and unplanned conversion to open hepatectomy (p=0.832) were similar between groups. AA patients were more likely to smoke (p=0.026), had higher BMI (p=0.0312), and higher rates of diabetes (p=0.003), hepatitis (p<0.001), hepatocellular carcinoma (p=0.002), hypertension (p<0.001), poor functional status (p<0.001), and increased American Society of Anesthesiology (ASA) classification (p=0.033). Both cohorts had similar hospital length of stay, however AA patients had a higher rate of readmission (12.4% vs. 11.1%, p=0.025). No significant difference in 30-day morbidity (34.2% vs. 33.8%, p=0.892) or mortality (1.78% vs. 1.41%, p=0.662) was seen between groups. Conclusion: Despite differences in patient characteristics between AA and Caucasian patients, race does not appear to be associated with procedure selection or perioperative morbidity or mortality following hepatectomy. Increased readmission rates in AA patients could be explained by patient characteristics and comorbidities. Further analysis is necessary to establish the independent predictors of readmission and clarify the role of race.