120 Background: Twenty-five percent of patients with colorectal cancer will present with unresectable disease. Palliative surgery has been shown to improve symptom control and improve patient satisfaction as well as demonstrate improved cost and decreased healthcare utilization. However, it is unclear what factors influence use. We sought to determine patient and hospital factors associated with palliative surgery use in advanced colorectal cancers. Methods: Using the National Cancer Data Base (NCDB) Participant User File from 2006 to 2012, 162,967 patients with metastatic colorectal cancer were identified. Hierarchical regression was used to evaluate patient factors associated with use of palliative surgery. Hospitals were then categorized into quintiles based on palliative surgery utilization. Results: On multivariable analysis, factors associated with palliative surgery included rectal tumor site (OR 1.63, 95% CI 1.49 – 1.77), Asian/Pacific islander race, Medicaid/uninsured status, and longer duration from diagnosis to treatment (p < 0.05 for all). After stratifying hospitals into quintiles of utilization, significant regional variation in use of palliative surgery was noted. The lowest likelihood of use of palliative surgery was the NCDB South Atlantic region (DC, DE, FL, GA, MD, NC, SC, VA, WV). Compared to this region, hospitals with high use of palliative surgery were more common in the Pacific (OR 2.08, 95% CI 1.9-2.26), West South Central (OR 2.60, 95% CI 2.39 – 2.84), East North Central (OR 4.15, 95% CI 3.86 – 4.46), Mountain (OR 4.72, 95% CI 4.22 – 5.27), West North Central (OR 5.30, 95% CI 4.83 – 5.83), East South Central (OR 5.42, 95% CI 4.97 – 5.92), Middle Atlantic (OR 6.75, 95% CI 6.24 – 7.30), and New England (OR 6.75, 95% CI 6.05 – 7.54) regions. Compared to community cancer centers, high utilization hospitals were more likely to be academic/research centers or comprehensive cancer centers. Conclusions: In metastatic colorectal cancer, race and socioeconomic status appear to play a role in use of palliative surgery. It appears that use is higher for patients at academic/research hospitals or comprehensive cancer centers. Significant regional variation also exists in use of palliative surgery.