EP354 - Five Year Data for a Complex Abdominal and Pelvic Surgery Service in an Underserved Population

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Purpose/Background: In 2019, we initiated a Complex Abdominal and Pelvic Surgery (CAPS) Program at Dignity Health Cancer Institute (DHCI) and St. Joseph’s Hospital and Medical Center (SJHMC) in Phoenix, Arizona for abdominal and pelvic cases that involve two or more surgical services. This program serves patients throughout Arizona and surrounding states. We analyzed our outcomes data after five years of the program’s existence.

Methods/Interventions: The project was approved by the DHCI and SJHMC Institutional Review Boards. We collected demographic, clinical, surgical outcomes, and follow-up data for the 130 patients seen through the program from June 2019 to June 2024. Ten patients were not operated and were excluded in the outcomes analysis. Data were compared using the Wilcoxon Rank Sum for continuous variables and Chi-squared analysis or Fisher’s exact test for categorical outcomes. The primary outcomes were 30-day mortality and 30-day complications.

Results/Outcomes: Demographics and surgical problems are shown in Figure 1. The biology of disease was 60% malignant and 40% benign. The median number of comorbidities was 3 (range 0-12), and the median number of medications was 4.5 (range 0-23). Patients had a median of 1 prior operation (range 0-9). Planned, urgent and emergent cases accounted for 91 (76%), 22 (18%), and 7 (6%) of cases respectively. The median number of surgical services involved was 2 (range 0-6) with a median of 4 procedures performed in each case (range 1-9). Operations performed and 30-day complications are shown in Figure 2. The most common core operation was abdominoperineal resection (28%). Surgery was performed minimally invasively in 16 cases (13%), of which 14 were robotic and 2 laparoscopic, and required a laparotomy in 92 cases (77%). Conversion rate from MIS to open was 10% (12 cases). Median operative time was 413 minutes (range 127-842) and median blood loss was 300 cc (range 25-5000). The median length of stay was 12 days (range 0-74). Three patients were lost to followup and 117 (90%) patients were analyzed for outcomes. The median length of follow-up was 414 days (range 7-1820). Within 30 days, readmission occurred in 28 patients (23%) and ER visits that did not result in admission occurred in 12 patients (10%). Fifty of 71 (70%) patients with malignancy were operated with curative intent. 40/50 (80%) patients received R0 resections. A small cohort of patients early on in the program with R1 resections were analyzed and IORT was considered more liberally with prospective planning to allow better local control.

The 30-day mortality rate was 2% (2/120). Seventy-four patients (62%) had at least one complication within 30 days. The most common complications were ileus (43) and fluid collection (22). Eighteen patients (15%) had an unplanned return to the OR within 30 days. Eight patients underwent operation for anastomotic leak, enterotomy, perforated ulcer, and bowel obstruction, while the remainder underwent operations for wound complication, abscess or fluid drainage, and other minor procedures. Significant factors affecting the 30-day complication rate included the number of prior operations (p=0.035), length of operation (p=0.032) and estimated blood loss (p=0.004).

Conclusion/Discussion: While resource-intensive, a complex and abdominal surgery program can be offered safely in underserved patients. The program provides surgical equity for patients who otherwise may not receive care due to complex biology and structural barriers to care.