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Effects of Rural versus Urban Patient Residence on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy
Ajay Varadhan1, Diep Nguyen1, Maykel Dolorit1, Gregory Fishberger1, Collin Chase1, Sarah Cool1, Jessica Cobb1, Harrison Strang1, Emily Weeden1, Rahul Mhaskar1, Joseph Garrett2, Carla Moodie2, Jacques Fontaine2, Jenna Tew2, Jobelle Baldonado2, Eric Toloza2.
1University of South Florida Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.

OBJECTIVE: Patient outcome disparities can be affected by rural vs. urban residences, such as lung cancer mortality having been reported to increase with residential rurality. We studied whether the rurality of patientsí residences affects perioperative outcomes after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
METHODS: We retrospectively analyzed 709 consecutive patients who underwent RAVT pulmonary lobectomy by one surgeon over 10.8 years. Using rural-urban commuting area (RUCA) codes and distance to nearest major urban cities, a two-step filter was implemented to classify patientsí residential ZIP codes as rural or urban. Perioperative outcomes, intraoperative complications, and postoperative complications were compared using Chi-Square (χ2) tests, Studentís t-tests, Fisherís exact tests, and Kruskal-Wallis tests, with p≤0.05 as significant.
RESULTS: The classification scheme provided 408 rural patients and 271 urban patients, with 30 patients unable to be categorized and excluded. Most intraoperative and postoperative complication rates were similar between groups. Incidence of prolonged air leak (PAL, p=0.04) was higher, and median chest tube duration (p=0.0007) and median hospital length of stay (LOS, p=0.014) were longer in rural patients (Table 1). Multivariable analysis demonstrated that age, rurality, and smoking status were significant independent predictors of chest tube duration while age and smoking status were significant independent predictors of hospital LOS.
CONCLUSIONS: Rural patients had similar rates of intraoperative and postoperative complications as urban patients but had higher incidences of PAL, longer chest tube duration, and longer hospital LOS. However, RAVT pulmonary lobectomy is accessible to and is feasible and safe in patients from rural ZIP codes.



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