Association of Neighborhood Disadvantage with Short- and Long-Term Outcomes After Pancreatectomy for Pancreatic Ductal Adenocarcinoma.

Autor: Marcinak CT; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Praska CE; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Vidri RJ; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Taylor AK; Division of Hematology, Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Krebsbach JK; School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Ahmed KS; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., LoConte NK; Division of Hematology, Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Varley PR; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Afshar M; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Weber SM; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Abbott DE; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Mathew J; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Murtaza M; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Burkard ME; Division of Hematology, Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Churpek MM; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA., Zafar SN; Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA. zafars@surgery.wisc.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jan; Vol. 31 (1), pp. 488-498. Date of Electronic Publication: 2023 Oct 02.
DOI: 10.1245/s10434-023-14347-w
Abstrakt: Background: While lower socioeconomic status has been shown to correlate with worse outcomes in cancer care, data correlating neighborhood-level metrics with outcomes are scarce. We aim to explore the association between neighborhood disadvantage and both short- and long-term postoperative outcomes in patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma (PDAC).
Patients and Methods: We retrospectively analyzed 243 patients who underwent resection for PDAC at a single institution between 1 January 2010 and 15 September 2021. To measure neighborhood disadvantage, the cohort was divided into tertiles by Area Deprivation Index (ADI). Short-term outcomes of interest were minor complications, major complications, unplanned readmission within 30 days, prolonged hospitalization, and delayed gastric emptying (DGE). The long-term outcome of interest was overall survival. Logistic regression was used to test short-term outcomes; Cox proportional hazards models and Kaplan-Meier method were used for long-term outcomes.
Results: The median ADI of the cohort was 49 (IQR 32-64.5). On adjusted analysis, the high-ADI group demonstrated greater odds of suffering a major complication (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.26-6.40; p = 0.01) and of an unplanned readmission (OR, 3.09; 95% CI, 1.16-9.28; p = 0.03) compared with the low-ADI group. There were no significant differences between groups in the odds of minor complications, prolonged hospitalization, or DGE (all p > 0.05). High ADI did not confer an increased hazard of death (p = 0.63).
Conclusions: We found that worse neighborhood disadvantage is associated with a higher risk of major complication and unplanned readmission after pancreatectomy for PDAC.
(© 2023. Society of Surgical Oncology.)
Databáze: MEDLINE
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