COLECTOMY OUTCOMES IN APPALACHIAN AND NON-APPALACHIAN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SINGLE CENTER STUDY

Abstract BACKGROUND Inflammatory bowel disease (IBD) requires complex management, and colectomy is an important intervention when medical therapy fails or complications arise. Postoperative outcomes vary by disease type, perioperative management, and patient characteristics. Appalachian populations are known to experience higher comorbidity burden, socioeconomic challenges, and healthcare disparities, yet surgical outcomes in this group remain poorly studied. METHODS We conducted a retrospective analysis of patients with IBD who had undergone colectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data from January 2016 through August 2023. Patients were stratified by county of residence, classified using the Appalachian Regional Commission (ARC) economic distress index. The ARC designates counties into five categories ranging from 「attainment」 to 「distressed」 based on poverty, unemployment, and per capita income. Patients with redo colectomy procedures (n = 5) and those residing outside Appalachian states (n = 7) were excluded. Primary outcomes were hospital length of stay, 30-day mortality, and 30-day readmission. Secondary outcomes included operative approach and perioperative factors. RESULTS A total of 293 patients with IBD who had undergone colectomy were identified. After exclusions, 281 patients were included: 186 (66.2%) from Appalachian counties and 95 (33.8%) from non-Appalachian counties. The mean age was 41.7 years, and 49.1% were male. Most patients were White (93.2%), with 5.7% Black or African American. Economic classifications included 37.7% from distressed counties, 20.6% at risk, 40.6% transitional, and 1.1% competitive. Most procedures were performed for Crohn’s Disease (80.4%), were laparoscopic (80.0%) and non-emergent (92.2%). Operative approaches were similar between groups. Appalachian patients demonstrated higher 30-day mortality (3.3% vs 1.1%, p = 0.17) and higher 30-day in-hospitalization (2.7% vs 0%, p = 0.43). Contrary to our hypothesis, 30-day readmission was lower among Appalachian patients compared with non-Appalachian patients (5.4% vs 10.5%, p = 0.146). CONCLUSION Although not statistically significant, Appalachian patients who had undergone colectomy demonstrated higher short-term mortality and hospitalization, while readmission rates were lower. These trends suggest potential differences in outcomes influenced by geography, socioeconomic distress, and healthcare access. Further investigation using multicenter data is warranted to better define surgical risks and develop strategies to reduce disparities in Appalachian populations with IBD.