{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:42:29Z","timestamp":1784875349298,"version":"3.55.0"},"reference-count":48,"publisher":"Harborside Press, LLC","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a \u201ctextbook outcome\u201d (TO) following a cancer operation among a nationally representative cohort of patients. <jats:bold>Methods:<\/jats:bold> Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression. <jats:bold>Results:<\/jats:bold> Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46\u20130.53; <jats:italic>P<\/jats:italic>&lt;.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43\u20131.64), extended length of stay (OR, 2.06; 95% CI, 1.93\u20132.21), 90-day readmission (OR, 1.15; 95% CI, 1.07\u20131.24), 90-day mortality (OR, 1.90; 95% CI, 1.70\u20132.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97\u20134.62) (all <jats:italic>P<\/jats:italic>&lt;.001). <jats:bold>Conclusions:<\/jats:bold> Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.<\/jats:p>","DOI":"10.6004\/jnccn.2024.7038","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T18:29:56Z","timestamp":1729621796000},"page":"610-616","source":"Crossref","is-referenced-by-count":3,"title":["Association of Intellectual and Developmental Disabilities With Worse Outcomes After Surgical Treatment of Cancer"],"prefix":"10.6004","volume":"22","author":[{"given":"Vivian","family":"Resende","sequence":"first","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"},{"name":"Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selamawit","family":"Woldesenbet","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erryk","family":"Katayama","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Musaab","family":"Munir","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrique Ara\u00fajo","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"},{"name":"Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mujtaba","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol","family":"Rawicz-Pruszy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"},{"name":"Department of Surgical Oncology, Medical University of Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Muntazir Mehdi","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama","family":"Waqar","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"},{"name":"Medical College, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parit","family":"Mavani","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"Res Dev Disabil","first-page":"419","article-title":"Prevalence of intellectual disability: a meta-analysis of population-based studies","volume":"32","author":"Maulik PK","year":"2011","unstructured":"Maulik PK, Mascarenhas MN, Mathers CD,  Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil 2011;32:419\u2013436."},{"key":"B2","series-title":"J Appl Res Intellect Disabil","first-page":"316","article-title":"A comparison of the prevalence of health problems among adults with and without intellectual disability: a total administrative population study","volume":"34","author":"McMahon M","year":"2021","unstructured":"McMahon M, Hatton C. A comparison of the prevalence of health problems among adults with and without intellectual disability: a total administrative population study. J Appl Res Intellect Disabil 2021;34:316\u2013325."},{"key":"B3","series-title":"Dev Disabil Res Rev","first-page":"6","article-title":"People with intellectual disability: what do we know about adulthood and life expectancy?","volume":"18","author":"Coppus AMW","year":"2013","unstructured":"Coppus AMW. People with intellectual disability: what do we know about adulthood and life expectancy? Dev Disabil Res Rev 2013;18:6\u201316."},{"key":"B4","series-title":"Lancet Public Health","first-page":"e356","article-title":"All-cause and cause-specific mortality among people with and without intellectual disabilities during the COVID-19 pandemic in the Netherlands: a population-based cohort study","volume":"8","author":"Cuypers M","year":"2023","unstructured":"Cuypers M, Koks-Leensen MCJ, Schalk BWM,  All-cause and cause-specific mortality among people with and without intellectual disabilities during the COVID-19 pandemic in the Netherlands: a population-based cohort study. Lancet Public Health 2023;8:e356\u2013363."},{"key":"B5","series-title":"Cancer","first-page":"1267","article-title":"Cancer-related mortality among people with intellectual disabilities: a nationwide population-based cohort study","volume":"128","author":"Cuypers M","year":"2022","unstructured":"Cuypers M, Schalk BWM, Boonman AJN,  Cancer-related mortality among people with intellectual disabilities: a nationwide population-based cohort study. Cancer 2022;128:1267\u20131274."},{"key":"B6","series-title":"JAMA Netw Open","first-page":"e2113014","article-title":"Association of intellectual disability with all-cause and cause-specific mortality in Sweden","volume":"4","author":"Hirvikoski T","year":"2021","unstructured":"Hirvikoski T, Boman M, Tideman M,  Association of intellectual disability with all-cause and cause-specific mortality in Sweden. JAMA Netw Open 2021;4:e2113014."},{"key":"B7","series-title":"Int J Environ Res Public Health","first-page":"9280","article-title":"Adapting a cancer screening education program for Native American women with disabilities","volume":"19","author":"Armin JS","year":"2022","unstructured":"Armin JS, Williamson HJ, Begay A,  Adapting a cancer screening education program for Native American women with disabilities. Int J Environ Res Public Health 2022;19:9280."},{"key":"B8","series-title":"BMJ Open","first-page":"e056974","article-title":"Cancer in deceased adults with intellectual disabilities: English population-based study using linked data from three sources","volume":"12","author":"Heslop P","year":"2022","unstructured":"Heslop P, Cook A, Sullivan B,  Cancer in deceased adults with intellectual disabilities: English population-based study using linked data from three sources. BMJ Open 2022;12:e056974."},{"key":"B9","series-title":"PLoS Med","first-page":"e1003840","article-title":"Cancer risk in individuals with intellectual disability in Sweden: a population-based cohort study","volume":"18","author":"Liu Q","year":"2021","unstructured":"Liu Q, Adami HO, Reichenberg A,  Cancer risk in individuals with intellectual disability in Sweden: a population-based cohort study. PLoS Med 2021;18:e1003840."},{"key":"B10","series-title":"Ann Surg","first-page":"e1118","article-title":"Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery","volume":"278","author":"Zondlak AN","year":"2023","unstructured":"Zondlak AN, Oh EJ, Neiman PU,  Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery. Ann Surg 2023;278:e1118\u20131122."},{"key":"B11","series-title":"Tizard Learn Disabil Rev","first-page":"51","article-title":"Overcoming challenges in diagnosing and treating cancers in people with intellectual disability: a case analysis","volume":"19","author":"Kiani R","year":"2014","unstructured":"Kiani R, Vahabzadeh A, Hepplewhite EA,  Overcoming challenges in diagnosing and treating cancers in people with intellectual disability: a case analysis. Tizard Learn Disabil Rev 2014;19:51\u201358."},{"key":"B12","series-title":"J Appl Res Intellect Disabil","first-page":"85","article-title":"\u2018Diagnostic overshadowing\u2019 amongst clinicians working with people with intellectual disabilities in the UK","volume":"17","author":"Mason J","year":"2004","unstructured":"Mason J, Scior K. \u2018Diagnostic overshadowing\u2019 amongst clinicians working with people with intellectual disabilities in the UK. J Appl Res Intellect Disabil 2004;17:85\u201390."},{"key":"B13","series-title":"Disabil Health J","first-page":"9","article-title":"Barriers to cancer screening for people with disabilities: a literature review","volume":"8","author":"Merten JW","year":"2015","unstructured":"Merten JW, Pomeranz JL, King JL,  Barriers to cancer screening for people with disabilities: a literature review. Disabil Health J 2015;8:9\u201316."},{"key":"B14","year":"1996","unstructured":"Mansell J, Ericsson K, eds. Deinstitutionalization and Community Living. Springer; 1996."},{"key":"B15","series-title":"Lancet Oncol","first-page":"e164","article-title":"Cancer detection, diagnosis, and treatment for adults with disabilities","volume":"23","author":"Iezzoni LI","year":"2022","unstructured":"Iezzoni LI. Cancer detection, diagnosis, and treatment for adults with disabilities. Lancet Oncol 2022;23:e164\u2013173."},{"key":"B16","series-title":"Lancet Oncol","first-page":"e174","article-title":"Cancer treatment and decision making in individuals with intellectual disabilities: a scoping literature review","volume":"23","author":"Boonman AJ","year":"2022","unstructured":"Boonman AJ, Cuypers M, Leusink GL,  Cancer treatment and decision making in individuals with intellectual disabilities: a scoping literature review. Lancet Oncol 2022;23:e174\u2013183."},{"key":"B17","series-title":"Eur J Oncol Nurs","first-page":"9","article-title":"A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities","volume":"36","author":"Witham G","year":"2018","unstructured":"Witham G, Haigh C. A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities. Eur J Oncol Nurs 2018;36:9\u201315."},{"key":"B18","series-title":"Intellect Dev Disabil","first-page":"405","article-title":"Characteristics of Medicare beneficiaries with intellectual or developmental disabilities","volume":"57","author":"Reichard A","year":"2019","unstructured":"Reichard A, Haile E, Morris A. Characteristics of Medicare beneficiaries with intellectual or developmental disabilities. Intellect Dev Disabil 2019;57:405\u2013420."},{"key":"B19","series-title":"Eur J Surg Oncol","first-page":"156","article-title":"Focusing on desired outcomes of care after colon cancer resections; hospital variations in \u2018textbook outcome\u2019","volume":"39","author":"Kolfschoten NE","year":"2013","unstructured":"Kolfschoten NE, Kievit J, Gooiker GA,  Focusing on desired outcomes of care after colon cancer resections; hospital variations in \u2018textbook outcome\u2019. Eur J Surg Oncol 2013;39:156\u2013163."},{"key":"B20","article-title":"ZIP Code Tabulation Areas (ZCTAs)","author":"United States Census Bureau","unstructured":"United States Census Bureau. ZIP Code Tabulation Areas (ZCTAs). Accessed June 26, 2023. Available at: https:\/\/www.census.gov\/programs-surveys\/geography\/guidance\/geo-areas\/zctas.html"},{"key":"B21","series-title":"J Natl Cancer Inst","first-page":"530","article-title":"Defining rurality: an evaluation of rural definitions and the impact on survival estimates","volume":"115","author":"Franks JA","year":"2023","unstructured":"Franks JA, Davis ES, Bhatia S,  Defining rurality: an evaluation of rural definitions and the impact on survival estimates. J Natl Cancer Inst 2023;115:530\u2013538."},{"key":"B22","article-title":"CDC\/ATSDR Social Vulnerability Index (SVI): Overview","unstructured":"CDC\/ATSDR Social Vulnerability Index (SVI): Overview. Accessed June 13, 2023. Available at: https:\/\/www.atsdr.cdc.gov\/placeandhealth\/svi\/index.html"},{"key":"B23","series-title":"J Intellect Disabil Res","first-page":"93","article-title":"People with intellectual disability and their health problems: a review of comparative studies","volume":"48","author":"Jansen DEMC","year":"2004","unstructured":"Jansen DEMC, Krol B, Groothoff JW,  People with intellectual disability and their health problems: a review of comparative studies. J Intellect Disabil Res 2004;48:93\u2013102."},{"key":"B24","series-title":"Front Public Health","first-page":"83","article-title":"Healthcare for persons with intellectual and developmental disability in the community","volume":"2","author":"Ervin DA","year":"2014","unstructured":"Ervin DA, Hennen B, Merrick J,  Healthcare for persons with intellectual and developmental disability in the community. Front Public Health 2014;2:83."},{"key":"B25","series-title":"J Appl Res Intellect Disabil","first-page":"431","article-title":"Health disparities of adults with intellectual disabilities: what do we know? What do we do?","volume":"27","author":"Krahn GL","year":"2014","unstructured":"Krahn GL, Fox MH. Health disparities of adults with intellectual disabilities: what do we know? What do we do? J Appl Res Intellect Disabil 2014;27:431\u2013446."},{"key":"B26","series-title":"Intellect Dev Disabil","first-page":"385","article-title":"The state of the science of health and wellness for adults with intellectual and developmental disabilities","volume":"51","author":"Anderson LL","year":"2013","unstructured":"Anderson LL, Humphries K, McDermott S,  The state of the science of health and wellness for adults with intellectual and developmental disabilities. Intellect Dev Disabil 2013;51:385\u2013398."},{"key":"B27","article-title":"Declaration on Health Parity for Persons with Intellectual and Developmental Disabilities","author":"American Association on Intellectual and Developmental Disabilities","year":"2006","unstructured":"American Association on Intellectual and Developmental Disabilities. Declaration on Health Parity for Persons with Intellectual and Developmental Disabilities. American Association on Intellectual and Developmental Disabilities; 2006."},{"key":"B28","series-title":"Am J Manag Care","first-page":"S284","article-title":"Integrated delivery systems: the cure for fragmentation","volume":"15","author":"Enthoven AC","year":"2009","unstructured":"Enthoven AC. Integrated delivery systems: the cure for fragmentation. Am J Manag Care 2009;15(10 Suppl):S284\u2013290."},{"key":"B29","article-title":"WHO global disability action plan 2014-2021","unstructured":"WHO global disability action plan 2014-2021. Accessed June 12, 2023. Available at: https:\/\/www.who.int\/publications-detail-redirect\/who-global-disability-action-plan-2014-2021"},{"key":"B30","series-title":"Am J Public Health","first-page":"S198","article-title":"Persons with disabilities as an unrecognized health disparity population","volume":"105","author":"Krahn GL","year":"2015","unstructured":"Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health 2015;105(Suppl 2):S198\u2013206."},{"key":"B31","series-title":"Health Aff (Millwood)","first-page":"1379","article-title":"Advancing health equity and reducing health disparities for people with disabilities in the United States","volume":"41","author":"Mitra M","year":"2022","unstructured":"Mitra M, Long-Bellil L, Moura I,  Advancing health equity and reducing health disparities for people with disabilities in the United States. Health Aff (Millwood) 2022;41:1379\u20131386."},{"key":"B32","series-title":"Arch Pediatr Adolesc Med","first-page":"244","article-title":"Disparities in the prevalence of disability between black and white children","volume":"157","author":"Newacheck PW","year":"2003","unstructured":"Newacheck PW, Stein REK, Bauman L,  Disparities in the prevalence of disability between black and white children. Arch Pediatr Adolesc Med 2003;157:244\u2013248."},{"key":"B33","series-title":"J Intellect Disabil","first-page":"131","article-title":"Cancer and breast cancer awareness interventions in an intellectual disability context: a review of the literature","volume":"25","author":"Walsh S","year":"2021","unstructured":"Walsh S, O\u2019Mahony M, Lehane E,  Cancer and breast cancer awareness interventions in an intellectual disability context: a review of the literature. J Intellect Disabil 2021;25:131\u2013145."},{"key":"B34","series-title":"Res Dev Disabil","first-page":"247","article-title":"The experiences of people with developmental disability in emergency departments and hospital wards","volume":"24","author":"Iacono T","year":"2003","unstructured":"Iacono T, Davis R. The experiences of people with developmental disability in emergency departments and hospital wards. Res Dev Disabil 2003;24:247\u2013264."},{"key":"B35","series-title":"Surgery","first-page":"479","article-title":"Increased complications after appendectomy in patients with cerebral palsy: are special needs patients at risk for disparities in outcomes?","volume":"154","author":"Dhiman N","year":"2013","unstructured":"Dhiman N, Chi A, Pawlik TM,  Increased complications after appendectomy in patients with cerebral palsy: are special needs patients at risk for disparities in outcomes? Surgery 2013;154:479\u2013485."},{"key":"B36","series-title":"JAMA","first-page":"505","article-title":"Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality","volume":"313","author":"Etzioni DA","year":"2015","unstructured":"Etzioni DA, Wasif N, Dueck AC,  Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA 2015;313:505\u2013511."},{"key":"B37","series-title":"Ann Surg","first-page":"898","article-title":"Textbook outcome: a composite measure for quality of elective aneurysm surgery","volume":"266","author":"Karthaus EG","year":"2017","unstructured":"Karthaus EG, Lijftogt N, Busweiler LAD,  Textbook outcome: a composite measure for quality of elective aneurysm surgery. Ann Surg 2017;266:898\u2013904."},{"key":"B38","series-title":"J Surg Oncol","first-page":"936","article-title":"Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma","volume":"121","author":"Sweigert PJ","year":"2020","unstructured":"Sweigert PJ, Eguia E, Baker MS,  Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol 2020;121:936\u2013944."},{"key":"B39","series-title":"J Gastrointest Surg","first-page":"1277","article-title":"Textbook outcomes in liver surgery: a systematic review","volume":"27","author":"Sweigert PJ","year":"2023","unstructured":"Sweigert PJ, Ramia JM, Villodre C,  Textbook outcomes in liver surgery: a systematic review. J Gastrointest Surg 2023;27:1277\u20131289."},{"key":"B40","series-title":"Harv Public Health Rev (Camb)","article-title":"Providing equitable access to health care for individuals with disabilities: an important challenge for medical education","volume":"44","author":"Lee MS","year":"2021","unstructured":"Lee MS, Diaz M, Bassford T,  Providing equitable access to health care for individuals with disabilities: an important challenge for medical education. Harv Public Health Rev (Camb) 2021;44."},{"key":"B41","series-title":"J Adv Nurs","first-page":"36","article-title":"Caring for adults with intellectual disabilities: perceived challenges for nurses in accident and emergency units","volume":"55","author":"Sowney M","year":"2006","unstructured":"Sowney M, Barr OG. Caring for adults with intellectual disabilities: perceived challenges for nurses in accident and emergency units. J Adv Nurs 2006;55:36\u201345."},{"key":"B42","series-title":"PLoS One","first-page":"e26977","article-title":"Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study","volume":"6","author":"Lin JA","year":"2011","unstructured":"Lin JA, Liao CC, Chang CC,  Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study. PLoS One 2011;6:e26977."},{"key":"B43","series-title":"BMJ Open","first-page":"e032772","article-title":"Scoping review protocol documenting cancer outcomes and inequalities for adults living with intellectual and\/or developmental disabilities","volume":"9","author":"Stirling M","year":"2019","unstructured":"Stirling M, Linton J, Ouellette-Kuntz H,  Scoping review protocol documenting cancer outcomes and inequalities for adults living with intellectual and\/or developmental disabilities. BMJ Open 2019;9:e032772."},{"key":"B44","series-title":"Dev Med Child Neurol","first-page":"211","article-title":"Adverse outcomes after major surgery in children with intellectual disability","volume":"63","author":"Huang SY","year":"2021","unstructured":"Huang SY, Chang CC, Lin CS,  Adverse outcomes after major surgery in children with intellectual disability. Dev Med Child Neurol 2021;63:211\u2013217."},{"key":"B45","series-title":"Ann Surg","first-page":"881","article-title":"County-level social vulnerability is associated with worse surgical outcomes especially among minority patients","volume":"274","author":"Diaz A","year":"2021","unstructured":"Diaz A, Hyer JM, Barmash E,  County-level social vulnerability is associated with worse surgical outcomes especially among minority patients. Ann Surg 2021;274:881\u2013891."},{"key":"B46","series-title":"J Appl Res Intellect Disabil","first-page":"600","article-title":"Self-management of health by people with intellectual and developmental disabilities","volume":"32","author":"Friedman C","year":"2019","unstructured":"Friedman C, Rizzolo MC, Spassiani NA. Self-management of health by people with intellectual and developmental disabilities. J Appl Res Intellect Disabil 2019;32:600\u2013609."},{"key":"B47","series-title":"J Rural Health","first-page":"650","article-title":"Rural hospitals are not associated with worse postoperative outcomes for colon cancer surgery","volume":"38","author":"Lansing SS","year":"2022","unstructured":"Lansing SS, Diaz A, Hyer M,  Rural hospitals are not associated with worse postoperative outcomes for colon cancer surgery. J Rural Health 2022;38:650\u2013659."},{"key":"B48","series-title":"Surg Clin North Am","first-page":"835","article-title":"Rural surgery and status of the rural workplace: hospital survival and economics","volume":"100","author":"Diaz A","year":"2020","unstructured":"Diaz A, Pawlik TM. Rural surgery and status of the rural workplace: hospital survival and economics. Surg Clin North Am 2020;100:835\u2013847."}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/22\/9\/article-p610.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/22\/9\/article-p610.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/22\/9\/article-p610.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T13:34:12Z","timestamp":1731504852000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/22\/9\/article-p610.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":48,"journal-issue":{"issue":"9"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2024.7038","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}