Background: Racial disparities in access to colorectal cancer screening and preoperative evaluation remain unclear. Emergent admission has emerged as a marker for lack of access to timely care. The present work aimed to evaluate the association of admission type with race among patients undergoing colorectal cancer surgery.

Methods: All adults with a diagnosis of colon/rectal cancer in the 2011-2020 National Inpatient Sample undergoing colectomy or rectal resection were identified. Multivariable regression models were developed to examine the association of admission type with race, major adverse events (MAE) including mortality and postoperative complications, costs, and length of stay (LOS). Interaction terms between year, admission type, and race were used to analyze temporal trends.

Results: Of 722,736 patients, 67.6% had Elective and 32.4% Emergent admission. Black (AOR 1.38 [95% CI 1.33-1.44]) and Hispanic (1.45 [1.38-1.53]) race were associated with significantly increased odds of Emergent operation relative to White. Over the study period, non-White patients consistently comprised over 5% greater proportion of the Emergent cohort compared to Elective. Furthermore, Emergent admission was associated with 3-fold increase in mortality and complications, 5-day increment in LOS, and $10,100 increase in costs. MAE rates among Emergent patients remained greater than Elective with a widening gap over time. Non-White patients experienced significantly increased MAE regardless of admission type.  

Conclusion: Non-White race was associated with increased odds of emergent colorectal cancer resection. Given the significant risk of adverse outcomes, systematic approaches to eliminate racial disparities in colorectal cancer screening and improve access to timely surgical treatment are warranted.