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Allocation of Postacute Care Services Differs Among Rural and Urban Patients after Colon Cancer Resection
Sara Myers1,2, Wang Pong Chan1,2, Elizabeth S Davis3
1From the Department of Surgery, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA (Myers, Chan, Murillo, Ng, Beresneva, Rivard, Sachs, Davids).
Rural patients undergoing colon cancer surgery face more complications and intensive care unit admissions. Despite greater availability of post-acute care services in rural areas, these patients have lower odds of receiving them, highlighting geographic inequities.
Area of Science:
- Oncology
- Health Services Research
- Rural Health
Background:
- Rural populations face higher post-operative complication rates after colon cancer resection compared to urban counterparts.
- Complications like surgical site infections and anastomotic leaks necessitate extensive long-term care, prompting investigation into rural-urban disparities.
Purpose of the Study:
- To investigate differences in postoperative outcomes and discharge disposition between rural and urban patients following colon cancer resection.
- To evaluate the impact of geographic location on patient complications, intensive care unit (ICU) admission, and post-acute care utilization.
Main Methods:
- Utilized the SEER-Medicare database (2014-2019) to identify patients who underwent colon cancer resection.
- Employed multivariable logistic regression to analyze rural-urban variations in complications, ICU admission, discharge disposition, readmissions, and reoperations.
- Examined county-level availability of post-acute care services using the Area Health Resource File.
Main Results:
- Rural patients (18%) experienced higher complication rates (24% vs. 22%) and ICU admissions (34% vs. 30%) despite lower comorbidity indices.
- Rural patients had significantly lower odds of discharge with post-acute care services (OR=0.76) despite higher per-capita availability of facilities and home healthcare agencies.
- Readmissions did not differ, but rural patients underwent more post-discharge reoperations (0.6% vs. 0.3%).
Conclusions:
- Rural patients undergoing colon cancer resection face increased complications and ICU admissions.
- Lower utilization of available post-acute care services in rural areas contributes to geographic inequities.
- Improving post-acute care delivery and access in rural regions is crucial to mitigate these disparities.
