Introduction
Gender and geographic access to care play a large role in health disparities in esophageal cancer care. We hypothesize rural patients will have worse peri-operative outcomes after esophagectomy, despite receiving care at a high-volume hospital.
Methods
Prospectively collected data from patients who underwent esophagectomy at a single academic medical center from 2003 to 2022 were analyzed based on gender and county, which were aggregated into existing state-level “metropolitan” versus “rural” designations. Demographics, pre-operative treatment, surgical complications, post-operative outcomes, and length of stay (LOS) of each group were analyzed using chi-squared, paired t-tests, and single-factor ANOVA.
Results
A cohort of 1545 patients were evaluated with 83.6% being men and 16.4% women. Men had a higher BMI (p=0.009), greater number of pack-years (p<0.001), and higher risk of CAD (p=0.002). Men had higher rates of pre-operative chemotherapy (p=0.002) and pre-operative radiation (p=0.003). Post-operatively, men experienced more recurrent laryngeal nerve paresis (p=0.004), while women experienced more chylothorax (p=0.01). Women had significantly longer hospital (p=0.002) and ICU (p=0.03) LOS, with no differences in 30-day mortality. When separated by geographic criteria, rural women were outliers, with significantly longer hospital LOS (p<0.001) and higher rates of ICU admission (p<0.001). Rural men had similar overall LOS and ICU visits compared to metropolitan men and women.
Conclusion
Rural women were more likely to have longer inpatient recovery processes after esophagectomy compared to female metropolitan or male counterparts. Future studies should focus on the impact of pre-operative social services assessment in eliminating disparities for rural based females undergoing esophagectomy.
Table 1: Per-operative outcomes of esophagectomy based on gender and county.
| Female Metro (n=210) | Female Non-Metro (n=43) | Male Metro (n=964) | Male Non-Metro (n=328) | |
|---|---|---|---|---|
|
Post-operative pneumonia (p=0.12) |
3.3% (7) | 7.0% (3) | 5.7% (55) | 8.2% (27) |
|
Post-operative ARDS (p=0.26) |
2.4% (5) | 0.0% (0) | 1.3% (13) | 2.7% (9) |
|
Anastomotic Leak (p=0.63) |
19.5% (41) | 20.0% (9) | 16.8% (162) | 15.8% (52) |
|
Recurrent Laryngeal Nerve Paresis* (p=0.04) |
1.0% (2) | 2.4% (1) | 5.3% (51) | 5.2% (17) |
|
Post-operative Chylothorax* (p=0.05) |
8.1% (17) | 11.6% (5) | 4.9% (47) | 4.3% (14) |
|
Hospital LOS (mean days ± STD)* (p<0.001) |
12.40 ± 11.64 | 17.02 ± 15.85 | 11.13 ± 9.60 | 11.34 ± 8.88 |
|
Initial Visit To ICU* (p<0.001) |
9.5% (20) | 18.6% (8) | 7.7% (74) | 10.6% (35) |
|
ICU LOS (mean days ± STD)* (p<0.001) |
1.10 ± 4.30 | 3.02 ± 10.10 | 0.55 ± 2.80 | 1.40 ± 6.43 |
|
30-day Mortality (p=0.16) |
1.4% (3) | 4.7% (2) | 0.9% (9) | 1.2% (4) |