Kirk, Frazer, Syed Ahmad, Syed Danial, Lam, Clayton, Yong, Matthew S., He, Cheng, Yadav, Sumit, Lo, Wing, Cole, Christopher, Windsor, Morgan, Naidoo, Rishendran, and Stroebel, Andrie (2023) Comparison of Lung Cancer Surgery Outcomes in Queensland for Indigenous and Nonindigenous Australians. JTO Clinical and Research Reports, 4 (10). 100567.

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Abstract

Introduction: Indigenous Australians (Aboriginal and Torres Strait Islander) have lower overall survival from lung cancer compared with nonindigenous Australians. Indigenous Australians receive higher rates of chemotherapy and/or radiotherapy. The equity of peri-operative care and thoracic surgical outcomes in Australian indigenous populations have not been contemporarily evaluated.

Methods: We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry Thoracic Database evaluating all adult lung cancer resections across Queensland from January 1, 2016 to April 20, 2022. Evaluating the time from diagnosis to surgery, operative data, and postoperative morbidity and mortality comparing Aboriginal and/or Torres Strait Islander people with nonindigenous Australians.

Results: There were 31 patients (2.56%) of 1208 who identified as indigenous. The mean age at surgery was 68.2 years versus 66 years in the indigenous and nonindigenous, respectively (p = 0.23). There was female predominance among indigenous patients (n = 28, 90.32%, p < 0.01) and the average body mass index was lower (22.52 versus 27.09, p < 0.01). There was no variation in the surgical parameters or histopathologic distribution of cancer type between groups. Multivariable logistic regression analysis suggested that indigenous patients were at elevated risk of blood transfusion (relative risk 3.9, p = 0.014, OR = 9.01, 95% confidence interval [CI]: 2.25–36.33, p < 0.01) and had greater transfusion requirements (risk ratio 4.08, p = 0.0116 and OR = 12.67, 95% CI: 2.25–71.49, p < 0.01); however, the influence of low absolute number of transfusions must be acknowledged here. Indigenous status was not associated with increased intensive care unit admission (OR = 1.79, 95% CI: 0.17–18.80, p = 0.62), return to operating theater (OR = 2.1, 95% CI: 0.24–18.15, p = 0.50), new atrial fibrillation (OR = 0.52, 95% CI: 0.07–4.01, p = 0.55), prolonged air leak (OR = 0.29, 95% CI: 0.04– 2.16, p = 0.228), or pneumonia postoperatively (OR = 4.77, 95% CI: 0.55–41.71, p = 0.16). With only three deaths, no meaningful trends were observed. Time from diagnosis to surgery was comparable in the indigenous and nonindigenous groups (88.6 d, 95% CI: 54.26–123.24 versus 86.2 d, 81.40–91.02, p = 0.87). Postoperative length of stay was not numerically or statistically different between groups. (indigenous 7.54 d versus nonindigenous 7.13 d, p = 0.90).

Conclusions: Indigenous patients are more likely to receive a blood transfusion than nonindigenous patients during lung resection. Reassuringly, the perioperative care provided to indigenous Australians undergoing lung resection in Queensland seems to be comparable to that of the nonindigenous population.

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