Back to 2025 Abstracts
THE HIDDEN BURDEN: IMPACT OF ALLOSTATIC LOAD ON COLORECTAL CANCER SURGERY OUTCOMES
Mujtaba Khalil
*, Selamawit Woldesenbet, Shahzaib Zindani, Zayed Rashid, Abdullah Altaf, Azza Sarfraz, Matthew Kalady, Samilia Obeng-Gyasi, Timothy M. Pawlik
Surgery, The Ohio State Wexner Medical Center, Columbus, OH
Background: Adverse neighborhood contextual factors and socio-environmental stressors can impact healthcare outcomes through various pathways, including environmental, psychosocial, and biological factors. One key measure, allostatic load (AL), represents the cumulative physiological damage caused by these socio-environmental stressors. Therefore, we sought to investigate the association between AL, social vulnerability, and postoperative outcomes following colorectal cancer (CRC) surgery.
Methods: Individuals who underwent surgery for CRC between 2022 and 2024 were identified using the Epic Cosmos database. AL consists of 10 biomarkers from four physiological systems: (1) cardiovascular—heart rate, blood pressure (systolic and diastolic); (2) metabolic—body mass index, alkaline phosphatase, blood glucose, and albumin; (3) renal—creatinine, blood urea nitrogen; and (4) immune—white blood cell count. AL is calculated by assigning 1 point for biomarkers in the worst quartile of the sample. Multivariable regression was used to examine the association between AL, postoperative complications, and 30-day mortality.
Results: A total of 40,520 individuals were included in the analytic cohort. Mean patient age was 67.7 years (SD ±13.9), most patients were male (n=20,573; 50.8%) and had a low Charlson Comorbidity Index (CCI) score (CCI < 2; n=33,132; 81.8%). Overall, 92.9% (n=37,623) of patients had low AL, while 7.1% (n=2,897) had high AL. Of note, individuals with high AL were more likely to be older (high AL: 70.3 years [SD ±12.5] vs. low AL: 67.5 years [SD ±14.0]), of African American ethnicity (high AL: 20.8% vs. low AL: 13.1%), and lived in socially vulnerable neighborhoods (high AL: 38.3% vs. low AL: 33.3%) (all p <0.001). Following surgery, individuals with high AL were more likely to experience complications (high AL: 51.0% vs. low AL: 38.4%) and mortality within 30 days (high AL: 11.0% vs. low AL: 5.0%) (both p<0.001) (
Table). Moreover, individuals with high AL were less likely to be discharged home (high AL: 49.5% vs. low AL: 61.8%; p<0.001). On multivariable analysis, after adjusting for sociodemographic and clinical factors, AL was associated with increased odds of postoperative complications (OR: 1.48, 95% CI: 1.38 – 1.58) and mortality within 30 days (OR: 2.13, 95% CI: 1.90 – 2.37).
Conclusion: High AL, a measure of underlying physiological stress, is associated with poorer postoperative outcomes and mortality following CRC surgery. These findings highlight the importance of addressing AL, particularly in individuals from socially vulnerable neighborhoods, as a potential risk factor for adverse surgical outcomes.
Postoperative complications stratified by allostatic load.
Back to 2025 Abstracts
