The effect of rural vs. urban setting on the management and outcomes of surgery for endometrial cancer

Abstract

IntroductionTo evaluate the proportion of endometrial cancers surgically managed in rural centers, and to compare the surgical management and perioperative morbidity of hysterectomies for endometrial cancer performed in rural settings with those performed in urban settings. Materials and methodsWe conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from 2003 to 2010. We included all patients diagnosed with endometrial cancer who underwent a hysterectomy and compared surgical approaches, lymph node dissection rates, perioperative complication rates, and lengths of stay according to location of care provided (rural versus urban centers), using multivariate logistic regression models. ResultsOf the 52,299 women who underwent surgery for endometrial cancer, 6% were performed in rural centers—a proportion that trended down over the study period. A disparity in surgical management was noted between rural versus urban settings, with rural centers having lower rates of laparoscopy and robotics (6.9% vs. 18.5%; OR 0.35, CI 0.30–0.40), and lower rates of lymph node dissection both overall (39.4% vs. 67.0%; OR 0.32, CI 0.30–0.35) and for early (37.2% vs. 66.2%; OR 0.30, 95%CI 0.28–0.33) and advanced (57.7% vs. 71.7%; OR 0.56, 95% CI 0.44–0.70) stage disease. Perioperative morbidity was comparable in both settings, with lower rates of transfusion, sepsis, wound infection, ileus, and prolonged hospitalization in rural settings. ConclusionsAlthough women obtaining care for endometrial cancer in rural centers receive differential surgical management than women cared for in urban centers, perioperative morbidity appears to be overall comparable.