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abstract
Preoperative experience for public hospital patients with gynecologic cancer: Do structural barriers widen the gap?
BACKGROUND
Widespread
disparities in care have been documented in women with gynecologic
cancer in the United States. This study was designed to determine
whether structural barriers to optimal care were present during the
preoperative period for patients with gynecologic cancer.
METHODS
A
retrospective review was conducted for patients undergoing surgery for a
gynecologic malignancy at a public hospital or a private hospital
staffed by the same team of gynecologic oncologists between July 1, 2013
and July 1, 2014.
RESULTS
Two
hundred fifty-seven cases were included for analysis (public hospital,
69; private hospital, 188). Patients treated at the private hospital
were older (58 vs 52 years; P = .004) and had similar medical
comorbidities (median Charlson comorbidity index at both hospitals, 6)
but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P
< .001). According to a multiple linear regression model, the public
hospital setting was associated with a longer interval from diagnosis
to surgery with adjustments for the insurance status, age at diagnosis,
cancer stage, and number of preoperative hospital visits (P < .001).
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