Race-based disparities in loss of functional independence after hysterectomy for uterine cancer

Abstract

Purpose Racial disparities in uterine cancer-related outcomes have been reported. The goal of this study was to determine if race, pre-operative body mass index (BMI) and medical comorbidities are predictors of loss of functional independence after surgery for uterine cancer. Methods Loss of independence was defined as a change from pre-operative functional independence, to a post-operative requirement of discharge to a post-care facility or death within the first 30 days following uterine cancer surgery. Demographic factors, comorbidities, BMI, intra-operative and post-operative outcomes and discharge status were abstracted from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Statistical analyses included multivariable logistic regression and Wald tests for interaction. Results 4,005 patients had uterine cancer and were functionally independent pre-operatively. After adjusting for clinical features and comorbidities, Black women were not significantly more likely to lose functional independence than non-Black women. However, a significant interaction (OR=1.17, p<0.001) was found between race and BMI for loss of functional independence. Interaction plots revealed worsening functional outcomes for Black women with BMI>40 but not in non-Blacks. Conclusions The interaction suggests a 17% increased odds of losing independence for each unit of BMI difference for Black uterine cancer patients, or 170% increased odds of losing independence for a 10-point increase in BMI, given a linear association. To reduce the likelihood of losing post-operative functional independence, Black, high BMI patients with or at-risk for uterine cancer may especially benefit from weight loss or interventions to optimize physical function.

Factors Associated with Duration of Rehabilitation Among Older Adults with Prolonged Hospitalization

“…This observational cohort study provides novel insights regarding the duration of rehabilitation provided to older adults during a prolonged hospitalization for a range of diagnoses, and highlights large disparities in RD within a large safety‐net hospital that may contribute to differences in clinical and functional outcomes 25,33‐39 . We found that hospitalized older adults received about 1 hour of multidisciplinary rehabilitation per week.…”