Background: Gender and geographic access to care play a large role in health disparities in esophageal cancer care. The aim of our study was to evaluate disparities in peri-operative outcomes for patients undergoing esophagectomy based on gender and geographic location. Methods: A retrospective cohort of prospectively collected data from patients who underwent esophagectomy from 2003 to 2022 was identified and analyzed based on gender and county, which were aggregated into existing state-level “metropolitan” versus “rural” designations. The demographics, pre-operative treatment, surgical complications, post-operative outcomes, and length of stay (LOS) of each group were analyzed using chi-squared, pairedt-tests and single-factor ANOVA. Results: Of the 1545 patients, men (83.6%) and women (16.4%) experienced similar rates of post-operative complications, but women experienced significantly longer hospital (p= 0.002) and ICU (p= 0.03) LOSs as compared with their male counterparts, with no differences in 30-day mortality. When separated by geographic criteria, rural women were further outliers, with significantly longer hospital LOSs (p< 0.001) and higher rates of ICU admission (p< 0.001). Conclusions: Rural female patients undergoing esophagectomy were more likely to have a longer inpatient recovery process compared with their female metropolitan or male counterparts, suggesting a need for more targeted interventions in this population.
背景：性别与就医地理可及性是导致食管癌治疗中健康差异的重要因素。本研究旨在评估基于性别和地理位置的食管切除术患者围手术期结局差异。方法：通过回顾性队列分析2003年至2022年接受食管切除术患者的前瞻性数据，依据性别及所在县区（归类为州级"都市"与"农村"划分标准）进行分组比较。采用卡方检验、配对t检验及单因素方差分析对各组人口统计学特征、术前治疗、手术并发症、术后结局及住院时长等指标进行统计分析。结果：在1545例患者中，男性（83.6%）与女性（16.4%）术后并发症发生率相近，但女性患者住院时长（p=0.002）及ICU停留时间（p=0.03）显著长于男性，30天死亡率无统计学差异。按地理区域分层分析显示，农村女性患者呈现显著异常值：其住院时长（p<0.001）与ICU入住率（p<0.001）均显著增高。结论：相较于都市女性或男性患者，接受食管切除术的农村女性患者住院康复周期显著延长，提示需要针对该人群制定更具针对性的干预措施。
Rural Women Have a Prolonged Recovery Process after Esophagectomy
肿瘤(癌症)患者之家