Inequities in early hospital discharge following resection of colorectal cancer.

BACKGROUND

Expeditious discharge following colorectal cancer (CRC) surgical resection has been associated with improved outcomes, reduced costs and resource utilization, and appears to be safe without increasing readmission rates. Despite these established advantages, the impact of sociodemographic, clinical, and regional factors on early postoperative discharge is not clear.

METHODS

We used the National Cancer Database (2010-2022) to perform multinomial logistic regression for odds of early (<3 days) and late (≥7-30 days) discharge versus standard (3-6 days) following surgical resection for patients with Stage I-III colon or rectal adenocarcinoma. We incorporated several sociodemographic, clinical, and regional characteristics; colon and rectal cohorts were analyzed separately.

RESULTS

Among 278,004 patients with colon cancer and 56,712 patients with rectal cancer, the strongest independent predictor of early discharge was robotic surgery (colon: OR=3.29, 95%CI=3.18-3.40; rectum: OR=1.32, 95%CI=1.23-1.41). However, Black patients (colon: OR=0.91, 95%CI=0.88-0.95; rectum: OR=0.91, 95%CI=0.87-0.95), those living rurally (colon: OR=0.94, 95%CI=0.90-0.98; rectum: OR=0.97, 95%CI=0.93-1.00), and non-privately insured patients were less likely to undergo robotic surgery. Compared with the privately insured, Medicaid (colon: OR=1.65, 95%CI=1.58-1.72, rectum: OR=1.43, 95%CI=1.33-1.53), Medicare (colon: OR=1.42, 95%CI=1.38-1.46; rectum: OR=1.34, 95%CI=1.26-1.43), and uninsured (colon: OR=1.52, 95%CI=1.44-1.61; rectum: OR=1.33, 95%CI=1.20-1.48) patients were more likely to be discharged late. Early discharge was associated with lower odds of 30-day readmissions (colon: OR=0.87, 95%CI=0.83-0.91; rectum: OR=0.73, 95%CI=0.65-0.82).

CONCLUSIONS

Increased uptake of robotic surgery and more equitable distribution of minimally invasive surgical approaches may increase opportunities for early discharge among marginalized patient populations.