EP501 - Characterizing the surgical burden and outcomes of colorectal cancer among rural populations in Louisiana

Sunday, May 10, 2026

1:40 PM - 1:45 PM ET

ePoster Presenter(s)

Connie C. Shao, MD, MSPH (she/her/hers)

Resident
Ochsner Medical Center
Ochsner Medical Center
New Orleans, LA, United States

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

Author(s)

Andrew Broussard, MD

General Surgery Resident
Ochsner Clinic Foundation
Ochsner Clinic Foundation
New Orleans, LA, United States

Disclosure information not submitted.
Cora Ianiro, MD

Research Fellow
Ochsner Medical Center
Ochsner Medical Center
New Orleans, LA, United States

Disclosure information not submitted.
W. Forrest Johnston, MD

Program Director, Senior Staff Surgeon
Ochsner Health
University of Queensland
New Orleans, LA, United States

Disclosure information not submitted.
BK

Brian R. Kann, MD (he/him/his)

Chair, Dept of Colon & Rectal Surgery
Ochsner Medical Center
New Orleans, LA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
William C. Kethman, MD (he/him/his)

Surgeon
Ochsner Medical Center
Ochsner Health
New Orleans, LA, United States

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

Charles Whitlow, MD

Surgeon
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.
DK

Danielle Kay, MD

Disclosure information not submitted.
David Vargas, MD

Senior Staff Surgeon and Vice Chair
Ochsner Clinic
New Orleans, LA, US

Disclosure information not submitted.
SS

Steven Schuetz, MD

Ochsner Medical Center

Disclosure information not submitted.
MZ

Matthew Zelhart, MD

Vice Chair
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.
DV

Dawn Veech, MSN, RN

Surgical Quality
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.
SB

Stephen F. Bardot, MD

Chairman of Urology, Director Surgical Quality and Safety
Ochsner Clinic
New Orleans, Louisiana, United States

Disclosure information not submitted.

Senior Author(s)

Jennifer L. Paruch, MD (she/her/hers)

Surgeon, Principal Investigator
Ochsner Medical Center
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Connie C. Shao, MD, MSPH: This individual has no financial relationships with ineligible companies.

Brian R. Kann, MD: This individual has no relevant relationships with ineligible companies.

William C. Kethman, MD: This individual has no relevant relationships with ineligible companies.

Purpose/Background: Rural–urban differences in colorectal cancer (CRC) care remain poorly understood. Social Vulnerability Index (SVI) offers a framework for assessing the impact of social determinants, but its relationship to disease presentation and outcomes is unclear.

Methods/Interventions: We conducted a retrospective cohort study of patients who underwent colectomy or proctectomy for CRC at Ochsner Health, captured in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from January 2019 to June 2025. Adult patients undergoing elective or emergent operations were included. We compared rural (n=241) and urban (n=641) patients. Demographics, comorbidities, tumor characteristics, operative details, parish-level incidence, and outcomes were compared. Social Vulnerability Index (SVI) percentile rankings were incorporated, including RPL1 (socioeconomic status), RPL2 (household composition and disability), RPL3 (minority status and language), RPL4 (housing type and transportation), and the overall RPL score representing composite vulnerability (0-1, higher score with greater percentile vulnerability). A subset analysis was performed among patients undergoing proctectomy (rural n=74, urban n=93).

Results/Outcomes: Patients from rural parishes were younger (62.6 vs 65.1 years, p=0.014), more often White (82.6% vs 63.7%, p< 0.001), less likely to be Black (12.9% vs 31.5%, p< 0.001), and had higher BMI (29.7 vs 28.2, p=0.007). Operative duration was longer for patients from rural parishes (278 vs 225 minutes, p< 0.001), likely because they more often underwent proctectomy (30.7% vs 14.5%, p< 0.001). Patients from rural parishes had higher levels of CRC incidence in their home parish (25.7 vs 22.7 per 100,000, p< 0.001). Overall, rural patients had lower SVI scores (overall 0.710 vs 0.792, p< 0.001), though RPL3 was similar. Postoperative morbidity and mortality were comparable.
In the proctectomy subset, rural patients again had higher BMI (29.4 vs 26.6, p=0.006), longer operative times (399 vs 358 minutes, p=0.040), and were more likely to come from parishes with elevated incidence (27.1 vs 23.4 per 100,000, p< 0.001). Tumor stage distribution and short-term outcomes were similar. Unlike the overall cohort, composite SVI did not differ significantly (0.771 vs 0.778, p=0.75), though specific domains (RPL2, RPL3) remained higher for urban patients.

Conclusion/Discussion: Rural patients undergoing CRC surgery experienced a higher burden of operative rectal cancer, longer operations, even for proctectomy alone, and elevated parish-level disease incidence despite residing in areas with lower overall social vulnerability. Within the high-burden proctectomy subset, SVI differences diminish, suggesting that structural or biologic drivers beyond neighborhood-level social risk may contribute to rural disparities. These findings underscore the need for targeted system-level interventions and appropriate social risk stratification to ensure equitable access and outcomes across geographic settings.