EP138 - Social Vulnerability is Associated with Urgent Presentation but not Worse Outcomes for Ulcerative Colitis Surgery at a Tertiary Referring Center

Saturday, May 10, 2025

3:53 PM – 3:58 PM PT

Location: Monitor 5, Sails Pavilion, Upper Level

ePoster Presenter(s)

Heather Carmichael, MD

Colorectal Surgery Fellow
Icahn School of Medicine at Mount Sinai
University of Colorado
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)

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.
Kirbi Yelorda, MD

Fellow
Ichan 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.
MP

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

Assistant Professor of Surgery
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.
SH

Sue J. Hahn, MD

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

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

Maia Kayal, MD, MS

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

Disclosure information not submitted.
RM

Roxanne Mistry, BA

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

Disclosure information not submitted.
EH

Elisabeth Hain, MD

Resident physician
Mount Sinai
Los angeles, California, United States

Disclosure information not submitted.
AG

Alexander J. Greenstein, MD

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

Disclosure information not submitted.
Sergey Khaitov, MD

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

Disclosure information not submitted.

Senior Author(s)

Patricia Sylla, MD (she/her/hers)

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

Disclosure information not submitted.

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

Heather Carmichael, MD: This individual has no financial relationships with ineligible companies.

Kirbi Yelorda, MD: This individual has no financial relationships with ineligible companies.

Michael C. Plietz, MD: This individual has no financial relationships with ineligible companies.

Sue J. Hahn, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Prior studies have demonstrated an association between higher neighborhood social vulnerability and inferior surgical outcomes for colorectal patients. This phenomenon has not been examined in patients with inflammatory bowel disease. In this study we aim to assess the association of the Social Vulnerability Index (SVI) with surgical outcomes for patients undergoing surgery for ulcerative colitis (UC) in a high-volume tertiary care center.

Methods/Interventions: Retrospective analysis of a prospectively maintained database identified patients who completed proctocolectomy with either ileal anal-pouch anastomosis (IPAA) or non-restorative approach for UC from January 2010 to December 2022. Patient addresses were geocoded and assigned estimated SVI at the census tract level. Patients were classified as high (≥0.7) and low ( < 0.7) SVI.

Results/Outcomes: A total of 767 patients underwent restorative or non-restorative surgery for UC; two patients were excluded for missing SVI. There were 145 patients with high SVI (18.9%). High SVI patients were more likely to be of minority race/ethnicity (44.7% vs. 11.7%, p< 0.001). No differences were found in baseline characteristics including duration of disease before surgery, age at surgery, patient sex, body mass index (BMI), smoking habits, presence of comorbidities, extra-gastrointestinal manifestations, and ASA score. Regarding preoperative medical therapies in the year prior to surgery, no significant differences were found in the use of steroids or biologics; however, patients in the high SVI group were less likely to be on immunomodulators (p=0.005). Surgical indications for refractory disease or cancer were similar in the two groups. However, high SVI patients were more likely to present urgently/emergently for their initial procedure (53.1% vs. 32.4%, p<.001). High SVI patients underwent restorative surgery at similar rates compared to low SVI patients (78.6% vs 84.0%, p=0.15); however, they were more likely to complete in 3 stages (62.1% vs. 53.2%, p=0.01).
Considering patients who underwent restorative proctectomy (n=635), baseline characteristics apart from minority race/ethnicity were again similar between groups. No difference in overall complication rate was found at the IPAA stage (43% vs. 51% p=0.14). Highly vulnerable patients did spend more total time living with a stoma between all stages (median 176 vs. 160 days, p=0.001); however, there were no differences in time living with a stoma in the subset of patients undergoing 3-stage procedures (192 vs. 187 days, p=0.48). Contrary to our hypothesis, high SVI patients were less likely to undergo open proctectomy and IPAA (10.5% vs. 26.5%, p< 0.001); however, this difference was driven by a high proportion of 2-stage procedures early in the study period being performed open.

Conclusion/Discussion: Our study found that while UC patients with high SVI undergoing surgery were more likely to present urgently/emergently and undergo 3-staged procedures, outcomes were similar to low SVI patients with high rates of restorative proctocolectomy and similar rate of surgical complications. High SVI patients overall spent more time living with a stoma due to higher frequency of a 3-stage approach. These findings suggest that equitable surgical care can be achieved at a tertiary referring center. Further research will help identify factors influencing acute presentation of UC in socially vulnerable patients.