S. Zindani1, M. Khalil1, S. Woldesenbet1, Z. Rashid1, A. Altaf1, J. Kawashima1, T.M. Pawlik1 1Ohio State University, Department Of Surgery, Columbus, OH, USA
Introduction: Roughly 61 million individuals in the United States live with a disability and face unique challenges that result in disparities in their healthcare. We aimed to evaluate the impact of disability on postoperative outcomes and the number of days at home.
Methods: Patients who underwent surgery for gastrointestinal (GI) cancer between 2017 and 2020 were identified using the Medicare database. Disability was defined as hearing, visual, intellectual, or motor impairment. Multivariable regression models were used to examine the association between disability and postoperative complications, discharge disposition, and the number of days at home.
Results: A total of 72,452 individuals underwent GI surgery (pancreas: n=7,614, 10.5%; hepatobiliary: n=4,994, 6.9%; colorectal: n=59,844, 82.6%) for a malignant indication. Median patient age was 75 years (IQR: 71–81), with the majority of patients being female (n=37,167, 51.3%). Overall, 5,432 individuals (7.5%) had a disability. Individuals with a disability were older (77 years [IQR: 72–82] vs. 75 years [IQR: 71–80]) and had a higher Charlson Comorbidity Index score (CCI >2: 63.9% vs. 53.5%) (both p<0.001). In the postoperative period, patients with disabilities were more likely to experience complications (4.6% vs. 3.3%), be discharged to a skilled nursing facility (26.6% vs. 12.3%), and experience a hospital readmission (20.0% vs. 13.5%). Consequently, individuals with disabilities were more likely to spend fewer (<20th percentile) days at home (33% vs. 19.2%) (all p<0.001). On multivariable analysis, disability was associated with higher odds of complications (OR: 1.36 95% CI: 1.19–1.56) and hospital readmission (OR: 1.55, 95% CI: 1.44–1.66). Additionally, disability was associated with higher odds of spending fewer healthy days at home (OR: 1.88, 95% CI: 1.77–1.99); healthcare expenditures were also 35% higher among individuals with a disability (%diff: 35.05, 95% CI: 32.67–37.48) (Figure).
Conclusion: Patients with disabilities are at a higher risk of complications, being discharged to a skilled nursing facility, and spending fewer days at home after a surgical procedure for a GI cancer. There is a need for targeted interventions to improve the care of patients with disabilities to ensure equitable oncological and surgical outcomes.