Location and Socioeconomic Vulnerability on Access and Early Outcomes in Benign Foregut Surgery

Improved surgical outcomes in benign esophageal disease are observed at high-volume centers, typically in metropolitan areas, potentially limiting access. This study examined social, geographic, and economic disparities, referral patterns, and outcomes between risk groups.

A retrospective study of adults undergoing benign esophageal surgery (2020-2023) was performed. Thirty-day complications, emergency indications, and time to surgical care were analyzed by degree urban classification, distance from home to hospital, Distressed Communities Index, and Social Vulnerability Index (SVI) using Mann-Whitney U or Fisher's exact tests.

A total of 143 patients met inclusion criteria. Rural/urban clusters comprised 51% (median distance to hospital of 20 miles [interquartile range 11-110]). DCI classified 43% as distressed, at-risk, or mid-tier, while 47% had a high or medium-high SVI. Thirty-day complications occurred in 13% of patients, with no differences by degree urban (P = 0.24), distance (P = 0.69), DCI (P = 0.09), or SVI (P = 0.36). Emergency surgery was required in 10.5% with no differences by degree urban (P = 0.58), distance (P = 0.74), DCI (P = 0.58), or SVI (P = 0.41). Severity at presentation and symptom duration did not differ by degree urban (P = 0.72, P = 0.48) or distance to the hospital (P = 0.75, P = 0.90). Patients from urban communities saw gastroenterology prior to referral for surgery more commonly (57%) than patients from rural areas (38%) (P = 0.01).

Nearly half of patients were from socially or economically vulnerable areas, yet no associations with 30-d surgical outcomes were identified. Patients in rural communities were more frequently referred directly to surgery, representing a critical access point and system adaptation for population trends.