375. RURAL PATIENTS HAVE A PROLONGED INPATIENT RECOVERY PROCESS AFTER ESOPHAGECTOMY COMPARED TO NON-RURAL PATIENTS AT A HIGH-VOLUME ESOPHAGEAL PROGRAM

Abstract

Abstract Background Geographic access to care plays a large role in health disparities in esophageal cancer care, with rural individuals often travelling further to access complex healthcare services. We sought to characterize peri-operative outcomes in patients undergoing esophagectomy for loco-regional cancer at a single academic tertiary care center based on geographic home location. We hypothesize that rural patients will have worse peri-operative outcomes after esophagectomy, despite receiving care at the same high-volume hospital. Methods Prospectively collected data from patients with loco-regional esophageal cancer who underwent esophagectomy at a single academic medical center between 2003 to 2022 were analyzed based on county. The counties were aggregated into previously existing state-level ‘metropolitan’ versus ‘rural’ designations per the Rural Health Information Hub guidelines. Distance traveled by the patients were calculated using driving distance between the patient’s reported zip code and hospital address. Demographics, pre-operative treatment, surgical complications, post-operative outcomes, length of stay (LOS), and mortality of the two groups were analyzed using chi-squared, paired t-tests, and single-factor ANOVA. Results The cohort consisted of 1545 patients with 76.0% from metropolitan counties and 24.0% from rural counties. Patients were more likely to be male in both groups (p = 0.004), with no significant differences in pre-operative characteristics. Both groups had similar rates of pre-operative chemotherapy (p = 0.11) and pre-operative radiation (p = 0.58). Rural patients traveled greater distances for healthcare services compared to metropolitan patients (rural: 192.4 ± 101.2 miles; metropolitan: 63.4 ± 36.7 miles; p < 0.001). Post-operatively rural patients had higher rates of pneumonia (p = 0.04) and more initial ICU visits (p < 0.001). Rural patients had longer ICU LOS (p < 0.001), but no difference in total hospital LOS (p = 0.28) or 30-day mortality (p = 0.35). Conclusion Rural patients tended to have a more complex inpatient recovery process after esophagectomy despite receiving surgery at the same high-volume institution and no differences in pre-operative characteristics (BMI, smoking history, and co-morbidities). It is unclear as to the reason for differences in pneumonia rates and ICU stays. Future studies should focus on the impact of rural location on disparities for individuals undergoing esophagectomy.