The Geography of Liver Resection: Travel Distance, Facility Volume, and Access to Specialized Care in an Urban Setting.

Abstract

Liver resection for colorectal liver metastases (CRLM) is a potentially curative treatment that is underutilized. Population-level data on disparities in access to liver surgery have been described, but municipality-level data are lacking. New York State Cancer Registry (NYSCR) and New York Statewide Planning and Research Cooperative System (SPARCS) datasets were linked to identify patients with synchronous, liver-only CRLM in New York State (NYS) and New York City (NYC) between 2010 and 2020. Demographic and treatment details were reviewed and patients were compared by using Pearson's chi-squared and Welch's t-tests. Geo-mapping was performed to determine driving distances between patient home addresses and their treating facility. Of 3,765 patients in NYS, 2,609 lived in NYC. The CRLM resection rate in NYS was 24% and 20% in NYC. Within NYC, treatment at a low-volume liver surgery facility (odds ratio [OR] 0.23, p < 0.001), positive primary lymph nodes (OR 0.34, p < 0.001), Medicare insurance (OR 0.62, p = 0.004), diagnosis of CRLM in 2015-2020 (OR 0.66, p < 0.001), and older age (OR 0.98, p < 0.001) were associated with a decreased likelihood of undergoing liver resection. History of prior colorectal resection (OR 4.44, p < 0.001) and farther distance to the treating facility (OR 1.03, p = 0.001) were associated with increased likelihood of undergoing resection. Within the unresected group, 18% bypassed a closer high-volume center for treatment at a farther low-volume center. Patients in NYC had lower rates of CRLM resection than in NYS. We identified municipality-level disparities in the receipt of liver surgery for CRLM, laying the foundation for the implementation of local interventions.