M. C. Turner1, Z. Sun1, M. L. Cox1, M. A. Adam1, B. F. Gilmore1, C. R. Mantyh1, J. Migaly1 1Duke University Medical Center,Department Of Surgery,Durham, NORTH CAROLINA, USA
Introduction: Emergent surgery for colon cancer is associated with poor short-term outcomes and worse long-term survival compared to elective resection. However, the socioeconomic factors predisposing patients towards emergent or urgent operations are not well defined. We aim to evaluate the impact of race and insurance coverage for patients undergoing urgent colon resection.
Methods: We performed a retrospective analysis of the 2006-2013 National Cancer Data Base (NCDB) for stage I-III colon adenocarcinomas. Differentiating the level of urgency of resection is difficult in retrospective studies. However, when the definitive resection and the diagnosis of cancer occur on the same day, the operation was likely non-elective. Patients with matching date of diagnosis and date of definitive operation were categorized as urgent surgery. We reviewed the oncologic outcomes of urgent compared to elective colon resection, while adjusting for patient, operation, tumor, and facility characteristics. We utilized multivariate regression to evaluate the socioeconomic factors of race and insurance coverage for patients requiring urgent resection.
Results: Among the 244,094 patients identified following colon resection, 59,918 (24.5%) underwent urgent resection. Those undergoing urgent operations had higher rates of positive margins (OR 1.36, p<0.01), 30-day mortality (OR 1.80, p<0.01), and worse long-term survival (HR 1.27, p<0.01). Overall, black patients (OR 1.15, p<0.01), and uninsured patients (OR 1.54, p <0.01) were more likely to undergo urgent resection. When stratified by race, among white patients those who are uninsured (OR 1.54, p <0.01) or have government insurance (OR 1.04, p <0.01) were more likely to undergo urgent resections compared to those who were privately insured. Similarly, among black patients, those who are uninsured (OR 1.42, p <0.01) were more likely to undergo urgent resections. When stratified by insurance status, race impacts urgent operations for those with private insurance (OR 1.12, p<0.01) and government insurance (OR 1.17, p <0.01), but not those who are uninsured (OR 1.07, p=0.27).
Conclusions: Urgent resection for colon adenocarcinoma has inferior oncologic outcomes than elective resection. Black race and a lack of insurance are associated with higher risk of urgent operation. Resources to mitigate this risk, such as screening colonoscopy, should be designated to these at-risk populations to improve equitable oncologic care.
