Association of community-level economic distress with perioperative outcomes after hepato-pancreato-biliary cancer surgery.

BACKGROUND

The influence of community-level economic distress on outcomes after hepato-pancreato-biliary (HPB) cancer surgery remains poorly characterized. We evaluated the association between the Distressed Communities Index (DCI) and perioperative outcomes among older adults undergoing HPB resection.

METHODS

Using 100% Medicare fee-for-service claims (2018-2021), we identified patients aged ≥66 years who underwent inpatient surgery for pancreatic, hepatic, or biliary cancers. County-level DCI scores were categorized into quintiles (prosperous to distressed). The primary outcome was in-hospital mortality; secondary outcomes included a prolonged length of stay (>75th percentile), discharge disposition, index admission Medicare payments, and receipt of perioperative therapy. Multivariable models were adjusted for demographic, clinical, regional, and hospital characteristics.

RESULTS

Among 15,565 patients, 6421 (41.3%) resided in prosperous counties and 831 (5.3%) resided in distressed counties. Patients from distressed counties were more often Black (19.1% vs 4.3%), nonmetropolitan (68.0% vs 5.3%), and treated at lower-volume hospitals (31.7% vs 29.8%) (all P <.001). Overall, in-hospital mortality was 5.4% (n = 841), increasing from 5.3% in prosperous counties to 7.3% in distressed counties (P =.021). After adjustment, residence in at-risk (adjusted odds ratio [AOR], 1.28; 95% CI, 1.12-1.46) and distressed counties (AOR, 1.29; 95% CI, 1.09-1.52) was associated with higher odds of in-hospital mortality compared with residence in prosperous counties. Prolonged LOS occurred more frequently among patients from distressed communities (26.2% vs 20.6%, P <.001). Receipt of preoperative radiotherapy was lower in distressed communities (2.2% vs 4.1%, P =.006). Index hospitalization Medicare payments were higher among patients from distressed counties (+$1994, 95% CI, 196-3791).

CONCLUSION

Community economic distress was associated with worse perioperative outcomes after HPB cancer surgery, supporting its potential role as an area-level risk marker for perioperative vulnerability.