# Rural Women Have a Prolonged Recovery Process after Esophagectomy

## TL;DR

Rural women face longer hospital stays and more ICU admissions after esophagectomy compared to urban women or men, highlighting healthcare disparities.

## Contribution

This study identifies rural-based women as a high-risk group with distinct recovery challenges after esophagectomy.

## Key findings

- Rural women had significantly longer hospital stays and ICU admissions after esophagectomy.
- Female patients overall had longer recovery times compared to male patients.
- Geographic location and gender combined to worsen outcomes for rural women.

## Abstract

Geographic access to care plays a large role in health disparities, especially with respect to esophageal cancer care. Given the increased regionalization of complex surgeries to major treatment centers, individuals from rural areas are required to travel further distances to access these complex healthcare services. Previous research has also shown gender disparities in surgical outcomes, with women less likely to receive curative cancer surgery. The aim of our retrospective study was to assess the peri-operative outcomes in patients undergoing esophagectomy for loco-regional esophageal cancer at a single academic tertiary care center based on geographic home location and gender. We found that rural women had a more complex inpatient recovery process (a longer length of hospital stay and a higher likelihood of being admitted to ICU) after esophagectomy compared with female metropolitan or male counterparts. Future studies focusing on the impact of pre-operative and post-operative interventions are needed to understand and eliminate disparities for rural-based females.

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, paired t-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.