V. Pandit1, B. Joseph1, H. Aziz1, M. Iyoob1, V. Nfonsam1 1University Of Arizona,Surgical Oncology/Surgery/Medicine,Tucson, AZ, USA
Introduction:
Disparities in the management of patients with various medical conditions is well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with colorectal diseases. We hypothesized that there is no difference among rural versus urban centers in the surgical management for colorectal diseases.
Methods:
We abstracted the national estimates for colorectal procedures from the National Inpatient Sample database 2011 (representing 20% of all in-patient admissions). Patients undergoing procedures (abscess drainage, hemmoroidectomy, fistulectomy, and bowel resections) were included. Patients with colon cancer were excluded. Patients were divided into two groups based on location: Urban and rural. Outcome measures were: in-hospital complications, mortality, and hospital costs. Sub-analysis of urban centers was preformed: centers with colorectal surgeons and centers without colorectal surgeons. Regression analysis was performed.
Results:
A total of 20,617 patients that underwent colorectal surgery intervention across 496 (Urban: 342, Rural: 154) centers were included. Of the urban centers, 38.3% centers had colorectal surgeons. Patients managed in urban centers had lower complication rate (7.6% vs. 10.2%, p=0.042), shorter hospital length of stay (4.7±3.1 days vs. 5.9±3.6 days, p=0.037) with higher hospital costs (56,820±27,691 vs. 49,341±2,598, p=0.046). On sub-analysis, patients managed in centers with colorectal surgeons had a 11% lower incidence of in-hospital complications (OR: 0.90, 95%CI: 0.74-0.94) and 7.2% (OR: 0.072, 95%CI: 0.65-0.81) shorter hospital length of stay in comparison to patients managed in urban centers without colorectal specialization.
Conclusion:
Disparities exit in patient outcomes managed in urban verses rural centers for colorectal surgery. Specialized care with colorectal surgeons at urban centers helps to reduce adverse patient outcomes. Steps to provide effective and safe surgical care in a cost effective manner across rural as well as urban centers is warranted.