M. Hargis1, J. A. Cruz Ayala1, D. A. Dooley1, D. Danos1, D. El-Giar1, A. S. Masango2, K. Pavleszek1, A. Gong2, V. N. Nfonsam1 1Louisiana State University Health Sciences Center, Division Of Colon And Rectal Surgery, Department Of Surgery, New Orleans, LA, USA 2University Of Arizona, College Of Medicine, Tucson, AZ, USA
Introduction:
Colorectal cancer is the second leading cause of cancer related deaths in the United States with up to one third of patients with colon cancer requiring emergent surgery. These patients usually have more advanced colon cancer with higher tumor grade and stage. Emergency colectomies for colon cancer have been associated with worse outcomes. The aim of this study is to understand the risk factors and disparities associated with emergent colectomy.
Methods:
We performed a retrospective analysis from 2018-2020 of the NCDB to evaluate disparities and contributing factors of patients undergoing emergent colectomy for colon cancer. Stage I-III colon cancer who underwent colectomies were included. Cases with rare histology, unknown grade, a primary site of appendix or sigmoidal junction, age less than 18 years, or missing demographic data were excluded. The primary outcome was emergent colectomy, defined as having definitive surgery within 24 hours of diagnosis. Categorical variables were collected, and bivariate associations were assessed using Chi square tests. Results are reported as adjusted odds ratios and 95% confidence intervals.
Results:
Of the 214,043 colon cancer patients, a total of 50,913 patients who underwent colectomy met the inclusion criteria. 38% of the patients had emergency resections. When adjusted for confounding variables, patients aged 65 and over were significantly less likely to have emergent resection than younger patients (Age 65-74=OR: 0.84; 95%CI:0.73-0.97; Age 75 and older=OR:0.80; 95%CI:0.70-0.93). There was no significant association between black race and emergent colectomies (OR:1.05; 95%CI:0.99-1.11, p=0.093). Uninsured (OR:1.17; 95%CI:1.05-1.31), Medicaid insured (OR: 1.20; 95%CI:1.12-1.29), and Medicare insured (OR: 1.10; 95%CI:1.03-1.16) were significantly more likely to have emergent colectomy than privately insured patients. Lower income area (OR:1.05; 95%CI:1.00-1.11), lower education area (OR:1.09; 95%CI:1.04-1.14), and non-metropolitan residence (OR:1.08; 95%CI:1.03-1.14) were also at increased odds of emergent colectomy. Readmission rates (p=0.019), 30-day mortality (p=<0.001) and 90-day mortality (p=<0.001), were significantly higher in the emergent colectomy group.
Conclusion:
Younger patients, uninsured and public insured, lower income and education area, and non-metropolitan residence are all associated with increased likelihood of undergoing emergent colectomy for colon cancer. Emergent colectomy was associated with higher readmission and mortality rates. Identifying modifiable risk factors, most of which are social determinants of health, will help clinicians develop better strategies to reduce emergent colectomies for colon cancer and improve outcomes.