Lack of disparities in postoperative care after ileocecal resection in patients with Crohn's disease at tertiary inflammatory bowel diseases centers.

Abstract

Background: Prior studies suggest that longer drive time (DT) to specialists and higher area deprivation index (ADI) are linked to worse outcomes in inflammatory bowel disease (IBD), but their impact on postileocolic resection (ICR) care in patients with Crohn's disease (CD) is not well defined.

Objectives: We aimed to evaluate disparities in post-ICR care based on DT and ADI.

Methods: Spatial analysis was performed with ArcGIS Pro to geocode patient and medical facility addresses with StreetMap Premium locators. High DT was defined as >60 min from the center. Data were analyzed using basic statistics and multivariate logistic regression.

Design: A retrospective cohort study was performed of CD patients' post-ICR care at two tertiary-care IBD centers (January 2018-March 2023).

Results: Our study included 293 patients; 44% had high DT. High DT had a higher median number of preoperative advanced therapy (2 vs 1, p = 0.007). Despite this, there was no difference between cohorts in median days to postop ileocolonoscopy (IOE; 257 vs 332, p = 0.59) and surgical recurrence rate (21% vs 27%, p = 0.278). Tobacco use and perianal disease were associated with increased odds of postoperative IOE (adjusted odds ratio (aOR) 2.09) and advanced therapy initiation (aOR 2.00).

Conclusion: We identified no differences in postoperative colonoscopy timing or surgical recurrence in patients with CD at two tertiary IBD centers based on DT or ADI. Given the lack of disparities in care delivery among patients treated in tertiary IBD centers, further comparative studies to care outside of specialized networks are needed to evaluate whether centralization to IBD centers is superior.