EPD306 - Race, Social Vulnerability, and Surgical Outcomes in Crohn’s Disease: Disparities After Ileocolic Resection

ePoster of Distinction Presenter(s)

• 

  Katherine W. Lam, MD

  Colorectal Surgery Research Fellow
  Icahn School of Medicine at Mount Sinai
  Westchester Medical Center
  New York, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• SC

  Sarah Cao, MD

  Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Michael C. Plietz, MD (he/him/his)

  Assistant Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• HC

  Heather Carmichael, MD

  Assistant Professor
  Department of Surgery, Division of Colon and Rectal Surgery
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• 

  Kirbi Yelorda, MD

  Fellow
  Ichan School of Medicine at Mount Sinai
  New York, NY, United States

  Disclosure information not submitted.
• JR

  Jordan Roy, MD

  Research Resident
  Icahn School of Medicine at Mount Sinai Hospital
  Icahn School of Medicine at Mount Sinai Hospital New York, NY
  staten island, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• DR

  Daniela I. Ramos-Delgado, M.D.

  Research Resident
  Icahn School of Medicine at Mount Sinai Hospital
  Hoboken, New Jersey, United States

  Disclosure information not submitted.
• 

  Jorge Zarate Rodriguez, MD

  Colon and Rectal Surgery Fellow
  Icahn School of Medicine at Mt Sinai
  Icahn School of Medicine at Mount Sinai
  New York, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• EP

  Elisa Paoluzzi Tomada, MD, MD

  Resident Physician
  Icahn School of Medicine at Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• At

  Alessia Laura taggiasco, MS6

  Medical student
  University Campus-biomedico of Rome
  Rome, Lazio, Italy

  Disclosure information not submitted.
• KM

  Kate Micallef, B.S.

  Research Assistant
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• AB

  Ashley Brown, n/a

  Medical Student
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• RM

  Roxanne Mistry, BA

  Clinical Research Coordinator II
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• HS

  Hannah Son, Bachelors of Science

  Clinical Research Assistant
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• 

  Victoria Yuan, MD (she/her/hers)

  General Surgery Resident
  New York Presbyterian Queens
  New York-Presbyterian/Queens
  Flushing, NY, United States

  Disclosure information not submitted.
• AD

  Adrienne N. Dean, MPH

  Medical Student
  Florida Atlantic University Schmidt College of Medicine
  Darien, Connecticut, United States

  Disclosure information not submitted.
• AR

  Alison P. Ricardo, MD

  Resident
  NewYork-Presbyterian Queens
  New York, NY, United States

  Disclosure information not submitted.
• SH

  Sue J. Hahn, MD

  Assistant Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• 

  Sergey Khaitov, MD

  Associate Professor of Surgery
  Icahn School of Medicine
  New York, New York, United States

  Disclosure information not submitted.
• AG

  Alexander J. Greenstein, MD

  Professor of Surgery
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Patricia Sylla, MD, FACS, FASCRS (she/her/hers)

  System Chief of Colon and Rectal Surgery
  Mount Sinai Hospital
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: The impact of social determinants of health on surgical outcomes among Crohn's disease (CD) patients remains underexplored. Ileocolic resection (ICR) is the most commonly performed procedure for medically refractory ileocolonic CD. We aimed to evaluate the associations of race/ethnicity, insurance type, and social vulnerability - quantified using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) - with postoperative outcomes following ICR at a large tertiary Inflammatory Bowel Disease (IBD) center.

Methods/Interventions: A retrospective analysis of adults who underwent ICR for CD (2018-2024) was conducted using an IRB-approved prospective surgical IBD database. SVI was geocoded at a census tract level, with high SVI defined as >0.7. Race/ethnicity was defined as non-Hispanic White or minority race/ethnicity (Hispanic/Latino, Black/African American, Asian, or other). Insurance was classified as private/commercial or public/other. Complicated ileocolonic CD was defined as the presence of fistula and/or intraabdominal abscess. Primary outcomes were 30-day complications and readmissions. Univariate analyses were performed, with categorical and continuous variables analyzed with chi-square and Mann-Whitney U tests, respectively. Multivariable logistic regression models included variables of interest and covariates of univariable significance to estimate adjusted odds ratios (aORs) for 30-day complications and readmissions.

Results/Outcomes: Among 816 patients who underwent ICR for CD, the 30-day complications and readmission rates were 19.6% and 6.9% respectively. Factors predictive of complications on univariate analysis included older age at surgery (p < 0.001), high SVI (p=0.009), higher Charlson comorbidity index (p=0.005), longer disease duration (p=0.002), higher ASA (p=0.010), preoperative systemic steroids (p=0.022), repeat ICR (p < 0.001), open approach (p < 0.001) and stoma creation at the time of surgery (p < 0.001) (Table 1). Factors predictive of readmissions included minority race/ethnicity (p=0.007), longer disease duration (p=0.005), non-elective presentation (p=0.011), repeat ICR (p=0.001), open approach (p < 0.001) and stoma creation at the time of surgery (p < 0.001). BMI, insurance type, and complicated ileocolonic CD were not associated with either outcome.

In multivariable models, high SVI was persistently associated with higher odds of 30-day complications (aOR 1.77 95% CI [1.15, 2.73], p=0.009) (Figure 1). Minority race/ethnicity also was persistently associated with increased odds of 30-day readmissions (aOR 2.35 95% CI [1.19, 4.65], p=0.014). Insurance type was not independently associated with either 30-day complications or readmissions (p>0.05). Stoma creation was a strong predictor for both complications (aOR 3.27 95% CI [1.76, 6.10], p< 0.001) and readmissions (aOR 3.73 95% CI [1.57, 8.36], p=0.003). Additional predictors of 30-day complications included an open approach (aOR 1.74 95% CI [1.14, 2.65], p=0.011) and male sex (aOR 1.50 95% CI [1.02, 2.21], p=0.040) while repeat ICR (aOR 1.93 95% CI [1.07, 3.49], p=0.028) and longer CD duration (aOR 1.02 95% CI [1.003, 1.047], p=0.023) were predictors of 30-day readmissions.

Conclusion/Discussion: Despite adjustments for perioperative factors, race and social vulnerability were independent predictors of 30-day complications and readmission. This highlights the persistent influence of structural and social determinants on surgical outcomes in CD patients.

Table 1 Univariate Analysis
Figure 1 Multivariate Analysis