Allocation of Postacute Care Services Differs Among Rural and Urban Patients after Colon Cancer Resection

BACKGROUND: Compared with urban, rural patients experience more postoperative complications, including surgical site infections and anastomotic leaks after colon cancer resection. As these complications often require long-term care, we investigated rural-urban differences in postoperative outcomes and discharge disposition. STUDY DESIGN: We identified patients who underwent colon cancer resection from the Surveillance, Epidemiology, and End Results-Medicare database (2014 to 2019). We used multivariable logistic regression models to evaluate rural-urban differences in complications, ICU admission, discharge disposition, readmissions, and postdischarge reoperations. County-level availability of postacute care services (skilled nursing, rehabilitation, home healthcare) was examined using the Area Health Resource File. RESULTS: Among 31,635 patients (urban = 82%; rural = 18%), more rural patients were White (88% vs 77%; p < 0.001), underwent open surgery (69% vs 60%; p < 0.001), and had surgery at nonacademic centers (44% vs 64%; p < 0.001). Stage was similar between the groups. Rural patients had lower Charlson Comorbidity Indices (p < 0.001) but more complications (24% vs 22%; p = 0.0039) and ICU admissions (34% vs 30%; p < 0.001). Rural patients had lower odds of being discharged with postacute care services (odds ratio 0.76, 95% CI 0.71 to 0.82); readmissions did not differ, but rural patients underwent more postdischarge reoperations (0.6% vs 0.3%, p = 0.0006). Rural counties had more postacute care facilities (8 [interquartile range [IQR] 5 to 13] vs 4 [IQR 3 to 5], p < 0.001) and home healthcare agencies per 100,000 (3 [IQR 0 to 7] vs 2 [IQR 1 to 5], p < 0.001) compared with urban. CONCLUSIONS: Rural patients experienced more complications and ICU admissions but had lower odds of being discharged with postacute care services, despite higher per-capita services and facilities available in rural areas. Improving postacute care delivery and usage in rural areas may reduce geographic inequities after colon cancer resection.