eP449 - Association Between Insurance Status and Long-term Outcomes in Colorectal Surgery in the Midwest

ePoster Presenter(s)

• 

  Ipek Sapci, MD

  General Surgery Resident
  University of Illinois College of Medicine at Peoria
  University of Illinois College of Medicine at Peoria
  Peoria, IL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Frank A. DiSilvio, Jr., MD

  Resident
  University of Illinois College of Medicine at Peoria
  University of Illinois College of Medicine at Peoria
  Peoria, IL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Ayo N. Gazal, MD (she/her/hers)

  General Surgery Resident
  University of Illinois College of Medicine at Peoria
  University of Illinois College of Medicine - Peoria
  Peoria, IL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• DM

  Derek Minor, MD

  General surgery resident
  University of Illinois College of Medicine - Peoria
  Peoria, Illinois, United States

  Disclosure information not submitted.
• OL

  Olivia Lee, BA

  Student
  University of Illinois College of Medicine Peoria
  Peoria, Illinois, United States

  Disclosure information not submitted.
• ES

  Eleni Stroumpi, n/a

  Research fellow
  UICOMP
  Peoria, Illinois, United States

  Disclosure information not submitted.
• JF

  Justin Fischer, MD

  Associate Professor
  University of Illinois College of Medicine at Peoria
  Peoria, Illinois, United States

  Disclosure information not submitted.

Senior Author(s)

• ST

  Steven Tsoraides, MD, MPH

  Attending Surgeon
  University of Illinois College of Medicine at Peoria, Springfield Clinic
  Peoria, Illinois, United States

  Disclosure information not submitted.

Purpose/Background: Insurance status can be a predictor of socioeconomic status and surgical outcomes. Growing data suggests that patients without insurance may have increased mortality rates. Our aim was to investigate the association between insurance status and long-term outcomes in patients undergoing colorectal surgery for cancer in a tertiary referral center in the Midwest.Methods/Interventions: Patients who underwent colorectal resections for cancer between 2015- 2020 were included in the study. Demographic characteristics, insurance status, disease stage, perioperative variables and long term outcomes were collected. Due to the number of patients in each group, patients in Black, Hispanic, Asian, Native American were analyzed in one group. These were compared using Fisher’s exact test for univariate analysis and p < 0.05 was considered statistically significant. Multivariate analysis was also performed.Results/Outcomes: A total of 753 patients were included in the study: 72 in medicaid group, 424 in medicare group, 241 in private insurance group, 16 in unknown/other insurance group. Patients who were 50 years old and younger were more likely to have private insurance (67% vs. 27%, p < 0.0001). Details of race, insurance status and disease Stage are listed in the Table. Medicaid and unknown insurance status was more common in Black, Hispanic, Asian and Other race group. (p < 0.0001). There was no difference in family history of cancer between the groups (P=0.44). Patients with Medicare insurance type were more likely to have metastases at the time of presentation (23%) (p0.007). Medicaid group had the highest rates of liver metastasis on presentation (16.6%, p=0.01) There was no difference in recurrence rates between the different insurance groups (p=0.9). Overall mortality was different between the groups, with Medicare group demonstrating highest rate of mortality (43%), followed by Medicaid (27.7%) (p < 0.0001). In multivariate analysis, insurance status was not associated with higher likelihood of disease recurrence (p=0.8).Conclusion/

Discussion: Our data shows that colorectal cancer outcomes differ based on insurance group. Stage IV disease at presentation is more likely in the Medicare group, while liver metastases specifically are more common in the Medicaid group. Similarly, these two groups showed higher mortality. Medicaid insurance was more common in the Black, Asian and Hispanic group. Insurance status was not a predictor of recurrence in our data. This data supports disparities in cancer outcomes based on socioeconomic factors including insurance type.Table. Comparison of Demographics, Outcomes based on Insurance Status