eP289 - Location, Location, Location: The Impact of Your Neighborhood on Outcomes Following Proctectomy for Rectal Cancer

Purpose/Background: Area deprivation index (ADI) is a validated comprehensive assessment of the social determinants of health using indicators from the US Census block group data reported as a composite score. The higher the ADI the more underserved the area. This study aimed to assess the impact of a patient’s ADI rank on surgical, pathological and survival outcomes following proctectomy for rectal cancer at a single region.Methods/Interventions: A single institution’s targeted National Surgical Quality Improvement Program (NSQIP) was used to identify all patients undergoing proctectomy for rectal cancer between January 2014 – December 2022. State ADI (indicated as a ranking 1-10) was assigned to each patient using addresses and data from the most recently published (2021) version of the database. The patients were categorized into Low ADI (1-4), Moderate ADI (5-6), High ADI (7-8) and Very High ADI (9-10) groups. The primary aim was to assess the impact of a patient’s ADI rank on survival after proctectomy for rectal cancer. Secondary outcomes included histopathologic outcomes and 30-day post-operative morbidity including: surgical site infection (SSI), discharge destination, post-operative need for transfusion, and 30-day readmissions.Results/Outcomes: One-hundred and four patients who underwent proctectomy for rectal cancer were included. ADI categories included the following: 42 as Very High, 30 as High, 21 as Moderate and 11 as Low . There were no significant differences in patient demographics, except for tobacco use (38% in the Very High and 18% in the Low group p=0.016). Post-operative outcomes including 30-day morbidity and hospital readmissions were similar between groups. Patients in the Very High and High ADI groups were significantly more likely to be discharged somewhere other than home after their surgery. The Very High group was more likely than the Low group to be discharged to either skilled nursing facilities (22% vs. 0%, p=0.05) or a long-term acute care facility (12% vs. 10%, p=0.05). The median time from diagnosis of rectal cancer to initiating treatment or surgery showed a trend toward significance with the Very High and High ADI group taking 46.3(±31.2) and 40.6(±21.0) days, respectively, to treatment vs. 39.3(±19.5) and 29.5(±11.2) days, respectively, in the Low and Moderate ADI groups. There were no significant differences in pathologic outcomes, including completeness of mesorectal excision and rate of positive margins. A Kaplan-Meier survival analysis showed no significant differences in overall survival among groups.Conclusion/

Discussion: ADI appears to play a role in a patient’s time to receiving treatment following rectal cancer diagnosis and impacts their postoperative disposition. There is a trend toward better survival in lower ADI populations however studies with larger sample size are needed to assess significance. Future studies with larger patient cohorts will help to fully define the role of ADI in predicting patient outcomes following proctectomy for rectal cancer."Table 1. Characteristics of Patients by ADI ranking

Table 2. Pathologic Outcomes
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