Bias Against Complex Lung Cancer Surgery.

Abstract Background Lung cancer remains a major public health problem. There remain differences in mortality among socioeconomic and racial groups. Using the STS GTS database, we attempted to determine whether there were differences in treatment choices by thoracic surgeons based on patient’s race or insurance. Methods Using data from 2012-2017, we analyzed the data from 75,774 patients with a diagnosis of lung cancer who had complete information on race and/or insurance was available and underwent a pulmonary resection. We categorized 66,614 (87.9%) operations into “standard” (lobectomy, bilobectomy, or wedge excision) and 9,160 (12.1%) into complex (pneumonectomy, sleeve or bronchoplastic resection, segmentectomy, or Pancoast resection) operations. Univariate and multiple variable logistic regression models were used to assess associations with receipt of a complex operation. Results Patients with private insurance had a higher incidence of complex operations (14.4%) than patients with government insurance (11.6%) (p Conclusions In this cohort of patients from the STS GTS database, white patients and those with private insurance had a higher incidence of complex operations. Many factors affect the decision to proceed with a complex thoracic surgical operation; type of medical insurance and race may represent two of them.