title: Disparities in Mangement of Patients with Benign Colorectal Disease: Impact of Urbanization and Specialized Care.
abstract: Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases. The national estimates of surgical procedures for benign colorectal diseases from the National Inpatient Sample database 2011 representing 20 per cent of all in-patient admissions were abstracted. Patients undergoing procedures (abscess drainage, hemmoroidectomy, fistulectomy, and bowel resections) were included. Patients with colon cancer and those who underwent emergency surgery were excluded. The population was divided into two groups: urban and rural, based on the location of treatment. Outcome measures were in-hospital complications, mortality, and hospital costs. Subanalysis of UC was preformed: centers with colorectal surgeons and centers without colorectal surgeons. Regression analysis was performed. A total of 20,617 patients who underwent surgical intervention for benign colorectal diseases across 496 (urban: 342, rural: 154) centers, were included. Of the UC, 38.3 per cent centers had colorectal surgeons. Patients managed in UC had lower complication rate (7.6% vs 10.2%, P < 0.001), shorter hospital length of stay (4.7 ± 3.1 vs 5.9 ± 3.6 days, P < 0.001), and higher hospital costs ($56,820 ± $27,691 vs $49,341 ± $2,598, P < 0.001) compared with rural centers. On subanalysis, patients managed in UC with colorectal surgeons had 11 per cent lower incidence of in-hospital complications [odds ratio: 0.89 (95% confidence interval: 0.76-0.94)] and a shorter hospital length of stay [Beta: -0.72 (95% confidence interval: -0.81 to -0.65)] when compared with patients managed in UC without colorectal specialization. Disparities exit in outcomes of the patients with noncancerous benign colorectal diseases managed surgically in urban versus rural centers. Specialized care with colorectal surgeons at UC helps reduce adverse patient outcomes. Steps to provide effective and safe surgical care in a cost-effective manner across rural as well as UC are warranted.
  
  
  METHODS
  Level III, retrospective cohort analysis.
authors.affiliation: Department of Surgery, University of Arizona Medical Center, Tucson, Arizona, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Jana
authors.initials: J
authors.lastname: Jandova
authors.forename: Tahereh Orouji
authors.initials: TO
authors.lastname: Jokar
authors.forename: Ansab Abbas
authors.initials: AA
authors.lastname: Haider
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Asad
authors.initials: A
authors.lastname: Asim
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassan
authors.forename: Valentine
authors.initials: V
authors.lastname: Nfonsam
mesh_terms: D003108:Colonic Diseases / Q000601:surgery*; D054625:Healthcare Disparities; D006801:Humans; D017063:Outcome Assessment, Health Care; D012002:Rectal Diseases / Q000601:surgery*; D012423:Rural Health / Q000706:statistics & numerical data; D012424:Rural Population; D013038:Specialization; D014504:Urban Health / Q000706:statistics & numerical data; D014505:Urban Population; D014507:Urbanization