Differences in Surgical Cancer Care Delivery and Outcomes Between Safety-Net and Non-Safety-Net Hospitals in the United States: A Comprehensive Systematic Review

Samir Alsalek; Kristie Q Liu; Jane S Han; Eisha A Christian; Frank J Attenello

doi:10.1002/jso.27950

Differences in Surgical Cancer Care Delivery and Outcomes Between Safety-Net and Non-Safety-Net Hospitals in the United States: A Comprehensive Systematic Review

J Surg Oncol. 2024 Oct 15. doi: 10.1002/jso.27950. Online ahead of print.

Authors

Samir Alsalek¹, Kristie Q Liu², Jane S Han², Eisha A Christian³, Frank J Attenello²

Affiliations

¹ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
² Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
³ Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 39402951
DOI: 10.1002/jso.27950

Abstract

Background: Studies evaluating the association of safety-net hospitals (SNHs) with outcomes of surgical care in cancer patients have demonstrated mixed results. We sought to systematically investigate the association of SNH status with measures of surgical cancer care delivery and outcomes.

Methods: A comprehensive review of the literature identified from the MEDLINE/PubMed, Embase, Web of Science, and Cochrane databases was performed according to the PRISMA guidelines. Risk of bias assessment was conducted using the Joanna Briggs Institute's tool. The findings were synthesized qualitatively.

Results: Of the 1749 records identified, 33 retrospective studies were included, 79% of which investigated national databases. Risk of bias assessment revealed average score of 78%. Among studies assessing each outcome, lower likelihood of receiving appropriate surgical interventions in SNH patients was reported by 85%; longer intervals to surgery by 100%; and prolonged hospital stays by 73%. Most studies reported no differences in survival (65%) or readmission (67%). Results were mixed regarding complications and mortality. Patient characteristics and shortage of resources and interdisciplinary teams were frequently proposed factors for observed disparities.

Conclusions: Cancer patients at SNHs may be less likely to undergo some surgical treatments and experience longer intervals to treatment but achieve largely comparable short- and long-term outcomes to non-SNH patients.

Keywords: cancer; outcomes; safety‐net hospitals; surgery.