Association of intellectual and developmental disabilities with worse outcomes after surgical treatment of cancer
Document Type
Article
Department
Medical College Pakistan
Abstract
Background: Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a "textbook outcome" (TO) following a cancer operation among a nationally representative cohort of patients.
Methods: Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression.
Results: Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46-0.53; P<.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43-1.64), extended length of stay (OR, 2.06; 95% CI, 1.93-2.21), 90-day readmission (OR, 1.15; 95% CI, 1.07-1.24), 90-day mortality (OR, 1.90; 95% CI, 1.70-2.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97-4.62) (all P<.001).
Conclusions: Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.
Publication (Name of Journal)
Journal of the National Comprehensive Cancer Network
DOI
doi.org/10.6004/jnccn.2024.7038
Recommended Citation
Resende, V.,
Woldesenbet, S.,
Katayama, E.,
Munir, M. M.,
Waqar, U.,
Lima, H. A.,
Khalil, M.,
-Pruszyński, K. R.,
Khan, M. M.,
Mavani, P.,
Endo, Y.,
Pawlik, T. M.
(2024). Association of intellectual and developmental disabilities with worse outcomes after surgical treatment of cancer. Journal of the National Comprehensive Cancer Network, 1-7.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_mc/487
Comments
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