Association of Intellectual and Developmental Disabilities With Worse Outcomes After Surgical Treatment of Cancer
Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
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Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
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Department of Surgical Oncology, Medical University of Lublin, Poland
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Medical College, Aga Khan University, Karachi, Pakistan
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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.
Submitted September 8, 2023; final revision received May 10, 2024; accepted for publication May 10, 2024. Published online October 22, 2024.
Author contributions: Study concept & design: Resende, Woldesenbet, Katayama, Rawicz-Pruszyński, Khan, Waqar, Mavani, Endo, Pawlik. Data curation & formal analysis: Woldesenbet, Katayama, Munir, Lima, Endo, Pawlik. Methodology: Resende, Woldesenbet, Lima, Rawicz-Pruszyński, Khan, Waqar, Mavani, Endo. Project administration: Resende, Woldesenbet, Katayama, Khalil, Pawlik. Supervision: Pawlik. Visualization: Woldesenbet, Katayama, Munir, Lima. Writing—original draft: Resende, Katayama, Rawicz-Pruszyński, Khan, Waqar, Mavani, Endo. Writing—review & editing: Munir, Lima, Khalil, Pawlik.
Data availability statement: The data for this study were obtained from the Medicare Standard Analytic Files. There are restrictions to the availability of this data, which is used under license for this study. Data can be accessed with permission from the Centers for Medicare and Medicaid Services.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7038. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
Supplementary Materials
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