Geographic factors influence outcomes of colorectal cancer surgery in NYC 2000-2004

B4

Theoretical Framework: Geographical information systems health care framework supports that there are spatial relationships in seeking health care and that distance and neighborhood may impact on choices of health care.
 Purpose: New York City (NYC) consists of 5 geographically related but demographically and socioeconomically diverse boroughs. This study examines the factors associated with perioperative mortality following colorectal surgery in NYC and how this impacts where patients chose to receive their care.
 Design/Method: The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for colorectal cancer surgery admissions from 2000-2004 and the following associated variables: type of surgery, borough of residence, location of hospital utilized, demographics, economic profile as evidenced by the median household income (MHI) by zip code, and surgical volume of treating hospitals. Associations were tested using an unadjusted Chi square and logistic regression models. Descriptive statistics were used for other variables.
 Results: Perioperative mortality following colorectal surgery differs significantly based on hospital volume, insurance type, age, and borough of surgery. The majority of patients were operated on in the borough of residence despite these significant variations in perioperative mortality. Minorities, Medicaid recipients, and lower MHI patients were more likely to be operated on in boroughs with lower income. The highest volume hospitals with lowest mortality were located in Manhattan. These hospitals treated either patients living in that borough, those from outside NYC, and rarely patients from the surrounding boroughs.
 Conclusion Implications:
 Despite apparent access to high volume, low mortality hospitals, the majority of NYC residents receive surgical care for colorectal cancer at local hospitals. Patients rarely seek care from geographically adjacent, higher volume hospitals located in adjoining boroughs. Further studies are needed to understand these trends and reduce the barriers that may limit patients’ access to high quality health care.