Allocation of Post-Acute Care Services Differs Among Rural and Urban Colon Cancer Patients After Resection

Background: Compared to urban, rural patients experience more post-operative complications including surgical site infections and anastomotic leaks following colon cancer (CC) resection. As these complications often require long-term care, we investigated rural-urban differences in postoperative outcomes and discharge disposition. Study design: We identified patients who underwent CC resection from the SEER-Medicare database (2014-2019). We used multivariable logistic regression models to evaluate rural-urban differences in complications, intensive care unit (ICU) admission, discharge disposition, readmissions, and post-discharge reoperations. County-level availability of post-acute care services (skilled nursing, rehabilitation, home-healthcare) was examined using the Area Health Resource File. Results: Among 31,635 patients (urban=82%; rural=18%), more rural patients were White(88% vs 77%;p<.001), underwent open surgery(69% vs 60%;p<.001), and had surgery at non-academic centers(44% vs 64%;p<.001). Stage was similar between the groups. Rural patients had lower Charlson Comorbidity Indices(p<.001) but more complications(24% vs 22%;p=0.0039) and ICU admissions(34% vs 30%;p<.001). Rural patients had lower odds of being discharged with post-acute care services(OR=0.76 95%CI=0.71-0.82); readmissions did not differ but rural patients underwent more post-discharge reoperations(0.6% vs 0.3%;p=0.0006). Rural counties had more post-acute care facilities [8 (IQR 5-13) vs 4 (IQR 3-5), p<.001] and home healthcare agencies per 100,000 [3 (IQR 0-7) vs 2 (1-5), p<.001] compared to urban. Conclusion: Rural patients experienced more complications and ICU admissions but had lower odds of being discharged with post-acute care services, despite higher per-capita services and facilities available in rural areas. Improving post-acute care delivery and utilization in rural areas may reduce geographic inequities following colon cancer resection.