A Systematic Review of Surgical Oncology Care at Safety-Net Hospitals in the United States

Introduction: Prior studies evaluating the association of safety-net status and outcomes in cancer patients undergoing surgical care have shown mixed results. We sought to systematically investigate the association between hospital safety-net status and various measures of receipt, type, timeliness, and short-/long-term outcomes of surgical oncology care.

Methods: A systematic review of literature published January 2000–July 2023 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The MEDLINE/PubMed, Google Scholar, and Cochrane databases were queried. English-language, peer-reviewed, quantitative studies comparing surgical oncology care between safety-net hospitals (SNHs) and non-safety-net hospitals (non-SNHs) were included. Studies were organized into the following categories: Receipt of surgery, type of surgical intervention (e.g., gross-total vs partial resection, minimally invasive surgery), time to surgery, operative outcomes (e.g., surgical margins, lymph node assessment), short- (e.g., mortality, length of stay, complications) and long-term outcomes (e.g., survival, readmission, recurrence).

Results: Of the 1799 records identified, 40 retrospective studies were included in the qualitative analysis, most of which investigated national databases (n=19, 47.5%). Survival (n=23, 57.5%) and receipt of surgical interventions (n=17, 42.5%) were the most commonly assessed metrics. SNH patients were associated with lower likelihood of undergoing gross-total resection, minimally invasive surgery, as well as optimal outcomes, specifically time to surgery and length of stay. Results were mixed regarding receipt of surgery, operative outcomes, mortality, complications, and long-term outcomes including survival and readmission. Patient characteristics, resource shortage, and lack of interdisciplinary oncologic care were frequently cited factors for the observed disparities in the type and timeliness of surgical interventions.

Conclusion : Current literature largely suggests that SNH patients are associated with lower likelihood of undergoing gross-total resection and minimally invasive surgery, as well as longer time to surgery. Despite this, there is no significant difference in short- and long-term outcomes.