eP537 - Impact of Social Determinants of Health on Early Discharge Following Colectomy for Colon Cancer: An NCDB Analysis

Purpose/Background: Early discharge after colectomy for colon cancer benefits both patients and hospital systems. There are limited data on the impact of social determinants of health on a population level scale for predicting early discharge times. We hypothesized that social determinants of health may influence the likelihood of early discharge in a large national sample.Methods/Interventions: A case-control study was conducted utilizing the National Cancer Database. Early discharge was defined as discharge within 2 days of surgery, standard discharge as 3-7 days after surgery and late discharge as more than 7 days after surgery. Age, gender, race, insurance status, educational and socioeconomic status, surgical approach, interval from diagnosis to surgery, facility type, and Charlson-Deyo Score were compared against hospital length of stay groups. Significant variables were used in a multivariate regression model to predict early discharge.Results/Outcomes: All patients who underwent colectomy for colon cancer between 2010-2018 were included. After removing all records with missing variables, the final cohort consisted of 166,839 records. The median age was 69 and 52% were female. The majority were non-Hispanic White (81%) and were on Medicare (58%). In a univariate analysis, access to robotic surgery was equal across all races, although African Americans were more likely to undergo open surgery (p < .0001). Only 11% of patients were discharged early, followed by 58% in the standard group and the remaining 31% in the late group. In a multivariate regression model, young age, non-Hispanic white race, private insurance status, non-academic center, lower Charlson-Deyo Score, high socioeconomic class, and shorter time from diagnosis to surgery were all associated with early discharge. The strongest predictors of early discharge were robotic approach (OR=3.4 [3.24-3.541] p= < .0001) and minimally invasive surgery OR=2.3 [2.21-2.31] p= < .0001).Conclusion/

Discussion: In a large national database, minimally invasive surgical approach was the strongest predictor of early discharge, with greater impact than sociodemographic factors. Increased uptake of robotic surgery and more equitable distribution of minimally invasive surgical approaches may improve early discharge rates among patients with social determinants of health. Prospective studies are needed to identify and correct barriers to minimally invasive surgery and early discharge in safety net populations.Factors Associated with Early Discharge Time