Journal Article

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

Vidri, Roberto J., Taylor, Amy K., Ahmed, Kaleem S., Burkard, Mark E., Krebsbach, John K., Zafar, Syed Nabeel, Churpek, Matthew M., Varley, Patrick R., Weber, Sharon M., Praska, Corinne E., Marcinak, Clayton T., Afshar, Majid, Mathew, Jomol, LoConte, Noelle K., Murtaza, Muhammed, Abbott, Daniel E.

2024

Overview

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.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adenocarcinoma / Carcinoma, Pancreatic Ductal - pathology / Gastric emptying / Humans / Medicine / Medicine & Public Health / Neighborhood Characteristics / Neighborhoods / Oncology / Pancreas / Pancreatectomy / Pancreatectomy - adverse effects / Pancreatectomy - methods / Pancreatic cancer / Pancreatic Neoplasms - pathology / Pancreatic Tumors / Retrospective Studies / Surgery / Surgical Oncology