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Session: ePoster: Benign Abdominal 8 (Mon115)

EP763 - Transportation and Internet Access are Critical for Improving Quality of Care and Outcomes for Diverticulitis Patients

Monday, May 12, 2025
1:53 PM – 1:58 PM PT

    ePoster Presenter(s)

  • Jessica K. Liu, MD, MS, MPH (she/her/hers)

    Clinical Scholar
    The American College of Surgeons
    Chicago, IL, United States

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

    • Author(s)

  • YL

    Yaoming Liu, PhD

    Senior Statistician
    The American College of Surgeons, Division of Research and Optimal Patient Care
    Chicago, Illinois, United States

    Disclosure information not submitted.

  • Sarah L. Remer, MD

    Clinical Scholar
    The American College of Surgeons, Division of Research and Optimal Patient Care
    Chicago, IL, United States

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

  • MC

    Mark E. Cohen, PhD

    Statistical Manager
    The American College of Surgeons, Division of Research and Optimal Patient Care
    Chicago, Illinois, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Clifford Y. Ko, MD

    Director, Division of Research and Optimal Patient Care, American College of Surgeons Professor and Vice Chair of Surgery and Professor of Health Services, UCLA Schools of Medicine, and Public Health
    American College of Surgeons , CA, US

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

All of the relevant financial relationships listed below have been mitigated.
Jessica K. Liu, MD, MS, MPH: This individual has no financial relationships with ineligible companies.
Sarah L. Remer, MD: This individual has no financial relationships with ineligible companies.
Clifford Y. Ko, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Optimal outcomes for patients with diverticulitis are dependent on reliable access to high quality care including use of mechanical bowel prep (MBP) with preoperative oral antibiotics (POA) for elective colectomies. Unwarranted variation in colorectal outcomes, however, exist by social, economic, structural, and environmental risk, all of which influence access to high quality health care. Specific mutable factors that can be targeted need to be identified. This study uses machine learning (ML) to evaluate a risk-adjusted outcomes registry linked to a validated socioeconomic (SES) predictive algorithm to elucidate mutable factors of social determinants of health.

Methods/Interventions: Addresses of elective colectomy patients diagnosed with diverticulitis treated at U.S. National Surgical Quality Improvement Program hospitals between January 1st, 2018 and June 30th, 2023 were geocoded to the block group level. Outcome-specific ML based logits were constructed and validated using 17 U.S. Census Bureau data components representing aspects of income, education, employment, housing, and household characteristics. Multivariable logistic regression was performed to evaluate the influence of ML logit values on receipt of MBP and POA, any major complication, and surgical site infection within 30-days of surgery. Mean Shapley values were calculated for each of the SES factors for each outcome to evaluate components’ relative contribution.

Results/Outcomes: Of the 29992 patients, 69% received MBP and 66% received POA. After adjusting for age, sex, race, body mass index, preoperative sepsis, comorbidities, American Society of Anesthesiologist class, and case complexity, higher SES was associated with use of MBP and POA. After adjusting for all covariates including MBP and POA, lower SES was associated with increased risk for any major complication and surgical site infection. Of the top contributing SES factors, potentially mutable factors included lack of access to a motor vehicle and to internet within a household.

Conclusion/Discussion: Addressing structural factors that impact patients from neighborhoods with lower SES should be considered as a key strategy for addressing colorectal disparities. Our results suggest that lack of access to transportation and information (i.e., internet), both of which can be targeted with interventions, influence access to best practices and optimal care for patients undergoing elective colectomies for diverticulitis. Knowing how each SES factor uniquely contributes to outcomes allows for more effective strategies to be deployed to improve quality of care.