Importance: American Indians (AIs) have the poorest cancer survival rates of any US ethnic group. Late diagnosis, poor access to specialty care, and delays in therapy likely contribute to excess mortality. Surgery plays a central role in therapy for solid organ cancer. Objective: To determine whether operative outcomes also contribute to poor long-term survival among AI patients with cancer. Design: Population-based retrospective cohort study comparing patient- and hospital-level factors and shortterm operative outcomes for AI and non-Hispanic white patients. Survey-weighted multivariate analyses assessed the effect of AI ethnicity on hospital location, inhospital mortality, and prolonged length of stay. Setting: A 20% stratified sample of all US community hospitals. Patients: Patients undergoing oncologic resection for 1 of 20 malignant neoplasms in the Nationwide Inpatient Sample from January 1, 1998, through December 31, 2009. Main Outcome Measure: In-hospital mortality, length of stay, and hospital location (rural vs urban). Results: Of 740 878 patients who met our inclusion criteria, 3048 were AIs. The AI patients were younger, more likely to undergo cancer surgery at rural hospitals, and more likely to be admitted for nonelective procedures and had more comorbidities than non-Hispanic white patients of similar ages (all, P<.05). The AI patients had comparable inpatient mortality and length of stay. Conclusions and Relevance: This investigation is the largest study of surgical outcomes among AIs to date and the first to focus on cancer surgery. This relatively young cohort does not experience poor outcomes after oncologic resection. Future research should uncover other factors in the continuum of cancer care that may contribute to the poor long-term survival of AI patients with cancer, including delivery of perioperative therapies. © 2013 American Medical Association. All rights reserved.