A. N. Krepline1, J. Mora1, M. Aldakkak1, S. Misustin1, K. Christians1, C. N. Clarke1, B. George2, P. S. Ritch2, W. A. Hall3, B. A. Erickson3, N. Kulkarni4, A. H. Khan5, D. B. Evans1, S. Tsai1 1Medical College Of Wisconsin,Division Of Surgical Oncology,Milwaukee, WI, USA 2Medical College Of Wisconsin,Division Of Hematology And Oncology,Milwaukee, WI, USA 3Medical College Of Wisconsin,Department Of Radiation Oncology,Milwaukee, WI, USA 4Medical College Of Wisconsin,Department Of Radiology,Milwaukee, WI, USA 5Medical College Of Wisconsin,Division Of Gastroenterology And Hepatology,Milwaukee, WI, USA
Introduction: Area of deprivation index (ADI) is a validated metric used to quantify socioeconomic disadvantages by neighborhood. The ADI is composed of 17 educational, employment, housing, and poverty measures abstracted from the US Census Long Form and the American Community Survey; higher ADIs signify a more disadvantaged neighborhood. We sought to examine the impact of ADI on readmission rates after surgery among patients with pancreatic cancer (PC).
Methods: Patients with resectable and borderline resectable PC treated at the Medical College of Wisconsin from 2009 to 2018 were identified. The ADI for all patients was obtained using the zip code+4 code. Patients were dichotomized into low and high ADI categories based on the median ADI. Demographic, clinicopathologic, and readmission data for patients were abstracted.
Results: Neoadjuvant therapy and surgery was completed in 310 patients with resectable and borderline resectable PC. The median ADI was 97.32 (IQR 17.7), 155 (50%) with low ADI and 155 (50%) with high ADI. No differences were observed between groups in demographic characteristics, clinical stage, baseline carbohydrate antigen 19-9, or type of neoadjuvant therapy received. In addition, no differences were observed between low and high ADI groups in the types of operation performed, need for vascular reconstruction, hospital length of stay, or pathologic stage. Of the 310 patients, 66 (21%) had a readmission within 90 days of surgery; 26 (17%) of the 155 patients with a low ADI and 40 (26%) of the 155 patients with high ADI (p=0.049). Among the low and high ADI groups, the most common reasons for readmission were procedure-related complications (n=16 (10%) vs. 23 (15%) patients, p=0.30) and failure to thrive (n=7 (5%) vs. 13 (8%) patients, p=0.25), respectively. For patients with low vs. high ADI, readmission occurred at a median of 19 days (IQR 14) and 27 (IQR 24), respectively (p=0.02). In a multivariable logistic regression, high ADI was associated with 1.80-fold increased odds of 90-day readmission (Table 1: 95% CI:1.02-3.16, p=0.04).
Conclusion: ADI was not associated with more advanced clinical or pathologic stage or operation performed. However, patients with high ADI were at increased risk for 90-day readmission. Additional studies are needed to identify modifiable factors associated with readmissions in this high-risk group.
