Ostomy and Anastomotic Leak Differences Among Rural and Urban Surgical Colon Cancer Patients

Area of Science:

• Colorectal Surgery
• Surgical Outcomes Research
• Health Disparities

Background:

• Rural populations face greater morbidity and mortality following colon cancer (CC) resection compared to urban counterparts.
• Ostomy creation is a potential strategy to mitigate anastomotic leaks (ALs), but its utilization varies by surgeon.
• Existing data lacks clarity on rural-urban differences in ostomy practices and subsequent AL rates after CC resection.

Purpose of the Study:

• To investigate rural-urban disparities in ostomy creation following CC resection.
• To evaluate the impact of ostomy practices on anastomotic leak (AL) rates and readmissions in rural versus urban CC patients.
• To identify factors contributing to the rural-urban difference in AL rates.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results-Medicare database (2014-2019) to identify patients undergoing CC resection.
• Employed multivariable logistic regression to assess rural-urban differences in AL and readmissions, considering ostomy status.
• Applied Oaxaca-Blinder decomposition to quantify the contribution of various factors (age, sex, race, comorbidities, cancer stage, surgical approach, surgeon specialty, ostomy) to the rural-urban AL disparity.

Main Results:

• Rural patients were less likely to undergo ostomy surgery (47.6%) compared to urban patients (52.4%).
• The rate of anastomotic leaks (ALs) was higher in rural patients who had ostomies (8.6%) versus urban ostomy patients (7.0%).
• Surgical approach accounted for 37.5% of the rural-urban AL disparity, surgeon specialty for 21.5%, and ostomy surgery for only 2.6%.

Conclusions:

• Ostomy surgery plays a minimal role in explaining the rural-urban disparity in anastomotic leaks (ALs) after colon cancer (CC) resection.
• Surgical approach is a significant factor, explaining over a third of the increased AL risk observed in rural populations.
• Interventions aimed at improving CC surgical outcomes in rural areas should prioritize optimizing surgical approaches.