A Retrospective Review of the Impact of Racial Disparities and Outcomes on Urinary Anastomotic Leak in Radical Prostatectomy in a National Surgical Registry

Background Racial disparities exist in prostate cancer incidence and mortality. Radical prostatectomy, a common treatment for prostate cancer, has been associated with increased complications in African American men compared to other racial groups. An anastomotic urinary leak is associated with prolonged hospitalization rates, increased rates of ileus, and a longer time to regain continence. This analysis aims to evaluate differences in urinary anastomotic leak (UAL) rates between racial groups and potential predictive factors for this disparity. Methodology The American College of Surgeons National Surgical Quality Improvement Program database (2019-2020) was utilized to compare rates of UAL in African American versus White patients. Preoperative variables examined included patient demographics, comorbid conditions, and surgical preparation. Other variables assessed included medical complications (such as pulmonary embolism), postoperative diagnosis, and surgical complications. Results A total of 11,010 radical prostatectomy patients were analyzed after applying selection criteria. African American men were more likely to be younger, current smokers, and on dialysis. African American men were also more likely to have had prior pelvic radiotherapy, diabetes mellitus, dyspnea, and hypertension controlled with medications. The odds of having a UAL in African American men after radical prostatectomy were 51% higher than in Whites (odds ratio = 1.51, 95% confidence interval = 1.02-2.17, p = 0.032). Prior pelvic surgery, chemotherapy within 90 days, mean operative time, and readmission rates were all associated with UAL in African American men postoperatively. Conclusions There is a significant disparity in the rate of UAL in African American versus White men and multiple factors may influence this difference.