EP2014 - Social Determinants of Health and Pelvic Exenteration Outcomes in a Public Health System: Evidence Supporting Centralization

ePoster Presenter(s)

• 

  Anthony Lim, MD

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  Los Angeles, California, United States

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

Author(s)

• 

  Alexis Peters, MD

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  University of Southern California/Los Angeles General Medical Center
  Los Angeles, CA, United States

  Disclosure information not submitted.
• 

  Jordan Martucci, MD

  Resident
  University of Southern California/ Los Angeles General
  Keck Hospital of USC/ Los Angeles General Medical Center
  Los Angeles, CA, United States

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

  Aubrey Swinford, MD

  Research Fellow
  Keck Medicine of USC
  University of Southern California
  South Pasadena, CA, United States

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

  Simon Kim, BS

  Medical Student
  Keck School of Medicine
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Sang W. Lee, MD

  Professor and Chief of Colon and Rectal Surgery
  Keck School of Medicine of USC
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Kyle G. Cologne, MD

  Professor of Surgery
  Keck School of Medicine of the University of Southern California
  Keck School of Medicine of the University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• JS

  Joongho Shin, MD

  Clinical Associate Professor
  Keck Medicine of USC
  Pasadena, California, United States

  Disclosure information not submitted.
• 

  Glenn Ault, MD, MSEd

  University of Southern California
  Los Angeles

  Disclosure information not submitted.
• AO

  Adrian Ortega

  Teaching faculty
  University of Southern California, CA, US

  Disclosure information not submitted.

Senior Author(s)

• SB

  Sacha Broccard, MD

  Assistant Professor of Clinical Surgery
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.

Purpose/Background: Pelvic exenteration is a highly complex procedure requiring a multidisciplinary approach. R0 resection rates are estimated around 65% and local recurrence rates up to 44%, depending on the type of cancer. This procedure is morbid with complication rates up to 86%. After this surgery, the one-year disease-free survival (DFS) and overall survival (OS) are 61% and 68-80% and three-year DFS and OS 22-78% and 25-75%, respectively. Neighborhood-level characteristics play a critical role in the distribution of health outcomes. Multiple studies have demonstrated inferior surgical outcomes in patients with higher socioeconomic stressors. Distressed community index (DCI) is a ZIP code based composite, socioeconomic metric which uses the latest census data to integrate multiple indicators of status (poverty rate, median income ratio, percentage change in employment, high school diploma rate, housing vacancy rate, percentage of adults not working, and percentage change in business establishments over the time period). Our study aims to explore outcomes of pelvic exenteration in relation to DCI scores at a safety-net hospital in Los Angeles County.

Methods/Interventions: The study was a retrospective case series involving patients who underwent pelvic exenteration for curative intent at a single institution safety-net hospital between April 2016 and February 2025. Clinical data was collected through chart review. DCI scores were obtained using the patients' primary residence ZIP code and the Economic Innovation Group 2024 DCI Database. Descriptive and univariate statistical analyses were performed in SPSS to evaluate clinical data such as R0 rate, recurrence, LOS, readmission rate, etc. To compare DCI score and time to event (recurrence, death, or last follow up), patients were separated into distressed (distressed and at-risk quintiles; DCI > 60) and non-distressed (mid-tier, comfortable, and prosperous quintiles; DCI < 60) and independent samples T-test was used. DFS and OS survival were estimated using Kaplan Meier curves.

Results/Outcomes: A total of 19 patients were included. R0 resection rate was 84%, wound infection rate was 11%, and 30-day mortality was 5% (1 patient). Local recurrence at one year was 16%, one-year DFS was 67%, and one-year OS was 94.4%. Three-year DFS and OS were 58.8% and 82.3%, respectively (Table 1). DCI scores in our cohort ranged from 5.90 to 91.10, with a mean of 61.18 (SD = 26.7) and a median of 65.4. Patients were distributed across all DCI quintiles. The distribution was not normal and skewed toward higher DCI scores (Figure 1). There was no significant difference in time to recurrence or death between distressed and non-distressed patients. There was also no significant difference between these groups in total LOS, ICU LOS, complication, readmission, reoperation, or local recurrence rates.

Conclusion/Discussion: At our safety-net hospital, complex pelvic surgeries have outcomes that are comparable to or surpass reported national benchmarks. Although more of our patients have higher DCI scores, there was no significant difference in clinical outcomes between distressed and non-distressed patients. More studies are needed to understand the impact from social determinants of health on patients within a public health system. The outcomes reported in this retrospective review support consideration of centralizing complex pelvic exenterations within the Los Angeles County Department of Health Services.

Table 1.
Clinical outcomes of pelvic exenteration in a public health system.
Figure 1.
The distribution of distressed community index scores across pelvic exenteration patients at our safety net hospital.