S. Wang1,2, H. Huang1, E. Scheufele1, I. Dankwa-Mullan1, G. P. Jackson1,2, Y. Arriaga1 1IBM Watson Health,Cambridge, MA, USA 2Vanderbilt University Medical Center,Nashville, TN, USA
Introduction: Time to surgery has been a well-known quality metric for colon cancer management, with evidence supporting improved clinical outcomes for patients who receive prompt versus delayed surgical therapy. We investigated trends and patient-related factors associated with time to surgery in a cohort of insured patients with colon cancer.
Methods: A cohort was identified from the IBM® MarketScan® database from January 2013 to December 2018. Inclusion criteria entailed patients 18 years and older with an initial diagnosis of non-metastatic colon cancer undergoing surgery within 6 months of diagnosis, with continuous insurance enrollment from 12 months pre- to 6 months post-diagnosis. Claims for surgery within six months after diagnosis were evaluated. Temporal trends for time to surgery were estimated by the Kruskal-Wallis test. Logistic regression identified factors associated with time to surgery.
Results: In this study, 20450 patients with non-metastatic colon cancer had surgery within 6 months of diagnosis. Median age was 62 years (IQR = 20 years), and 9998 (49%) were female. Median time to surgery was 13 days. A statistically significant difference in time to surgery was found comparing 2013 (median 12 days) to 2018 (median 16 days) (p < 0.0001). Factors associated with undergoing expedited surgery (within 1 week of diagnosis) included: older age (p=0.05), female sex (p = 0.016), coronary artery disease (p=0.014), smoking (p < 0.0001), dementia (p =0.001), hemiplegia or paraplegia (p = 0.001), renal disease ( p=0.029), and resident of US South (p=0.012) or US Midwest (p=0.03). Conversely, male sex (p=0.027), residency outside of the US West (p=0.022), obesity (p<0.001), severe liver disease (p=0.011), and myocardial infarction (p=0.019) were associated with a higher likelihood of delayed surgery (greater than 1 month after diagnosis).
Conclusion: For patients with non-metastatic colon cancer, time to surgery demonstrated a significantly increasing trend from 2013 to 2018. Numerous demographic, clinical, and geographic factors were associated with expedited or delayed time to surgery. Identifying these factors may provide insights into the groups of patients at risk for delayed surgical treatment and could support interventions to optimize surgical outcomes and foster equitable delivery of surgical care.