Race, Ethnicity, and Payor status Impact the Surgical Approach and Postoperative Outcomes of Lung Cancer Amongst Patients within The Society of Thoracic Surgeons General Thoracic Surgery Database

Objective: To evaluate demographics and quality metrics across racial and ethnic groups amongst patients undergoing lung resection for non-small cell lung cancer (NSCLC) within the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). Summary Background: Studies evaluating disparities amongst patients undergoing lung resection for NSCLC are limited. Methods: A retrospective cohort analysis of the STS GTSD was performed between 2015-2022. Multivariable logistic regression was performed for operation (wedge versus anatomic resection), operative approach (open versus minimally invasive), 30-day major morbidity, and combined 30-day morbidity/mortality. Non-Hispanic White patients were the reference group. Results: 103,407 patients underwent resection between 2015-2022. Patients identified as White (88,153; 85.6%), Black (8,924; 8.6%), Asian/PI (4,028; 3.90%), American Indian (274; 0.26%), and Other race (2,028; 1.96%). Black and Hispanic patients were less likely to receive a minimally invasive surgery (MIS) (aOR 0.92 [0.86–0.98], 0.72 [0.70–0.75], respectively). Patients with Medicare (aOR 1.21, 95% CI: 1.08–1.36) or dual Medicare-Medicaid coverage (aOR 1.29, 95% CI: 1.14–1.44) had higher odds of postoperative morbidity, as well as combined morbidity/mortality (Medicare: aOR 1.21, 95% CI: 1.08–1.35; dual coverage: aOR 1.27, 95% CI: 1.13–1.42), compared to those with commercial insurance. These payor types were most prevalent among Black and Hispanic patients. Conclusions: Surgical volumes for racial and ethnic minorities with operable NSCLC remain disproportionately low. Black and Hispanic patients experience disparities in key quality metrics, including lower likelihood of receiving MIS. Payor status was strongly associated with postoperative complications. These findings underscore the need for targeted interventions.