eP284 - Colon Cancer Diagnosis in the Emergent Setting: Recent Trends and Predictive Factors

Purpose/Background: Recent shifts in colon cancer screening due to the COVID-19 pandemic and higher rates of early-onset colon cancer have led to increased numbers of inpatient diagnosis and subsequent emergency surgical treatment . We sought to objectively quantify this and determine potential causative factors.Methods/Interventions: Retrospective review was conducted of all patients treated for colon cancer at a single academic tertiary care facility between 2012 and 2021. We collected information about the setting of diagnosis, timing of resection, presenting symptoms, and demographics.ANOVA linear trend analysis was used to identify trends over time in five major outcomes: setting of diagnosis, surgery during index admission, elective vs. emergent resection, and obstruction and/or perforation at time of surgery. Binomial regression was used to determine associations between said outcomes and various preoperative and demographic factors.Results/Outcomes: A total of 784 patients were included in this study. Three hundred sixty-nine (49.4%) were diagnosed in the inpatient setting and 180 (25%) underwent surgery during index admission. Of patients who underwent resection, 125 (27.2%) were in an urgent/emergent setting. One hundred thirty-six (17.3%) were obstructed and 50 (6.4%) were perforated at time of surgery. There was a statistically significant upward trend over time in obstruction (p=0.002) and perforation (p=0.04) at time of surgery. Inpatient diagnosis, surgery during index admission, and urgent/emergent resection also trended upward over time but were not significant. Likelihood of inpatient diagnosis was higher for active smokers (OR=2.44 [1.23,4.84]) and lower for patients with family history of inflammatory bowel disease (OR=0.10 [0.01-0.91]) or hereditary cancer syndromes (OR=0.06 [0.01, 0.50]). Odds of surgery during index admission were increased for patients with Medicaid (OR=5.17 [1.79,14.94]) and active smokers (OR=2.14 [1.05,4.39]). Patients with Medicaid were more likely be perforated at time of surgery (OR=4.61 [1.00, 21.14]). Likelihood of urgent/emergent resection decreased with age (p=0.04). Elective resection was positively associated with family history of colon cancer (OR= 2.52 [1.06, 6.04]), and was negatively associated with weight loss (OR=0.45 [0.21, 0.95]). Eligibility for screening colonoscopy based on age did not significantly affect any of the above outcomes.Conclusion/

Discussion: Our findings demonstrate upward trends in emergent presentation and treatment of colon cancer despite an increasing number of colorectal surgeons and screening colonoscopies performed at our institution over the study period. This may be the result of an urban population with decreased access to screening, as evidenced by Medicaid status being a risk factor for emergent presentation. This trend may also be due to effects of the COVID-19 pandemic, during which time preventative care became more difficult to access. We hope to use the risk factors identified here to reduce rates of emergent presentation and treatment in our patient population."Table 1

Population characteristics
Figure 1

Graphs represent trends over time for various outcomes. The dashed lines denote actual data points whereas the solid lines are trend lines."