CONCLUSIONS: Population-based mortality rates for major liverresections may be higher than those reported in the literature. In-formed consent should reflect actual local and national mortalityrates rather than selective reports from the literature.

Patient satisfaction with breast reconstructionduring the longterm survivorship periodEmily Hu, MD, Andrea Pusic, MD, Jennifer Waljee, MD, MPH,Latoya Kuhn, MPH, Edwin Wilkins, MD,Amy Alderman, MD, MPHUniversity of Michigan, Ann Arbor, MI

INTRODUCTION: Understanding reconstructive outcomes in thebreast cancer survivorship period has important implications forshared-medical decision-making. Unfortunately, long-term data onpatient-reported satisfaction with breast reconstruction are limited.Our goal was to compare long-term patient satisfaction with thedecision-making process and physical appearance between implantand autogenous tissue breast reconstruction.

METHODS: We surveyed 228 women who have had breast recon-struction (RR 73%) since 1977: expander/implant (N�111) andtransverse rectus flap (TRAM) reconstructions (N�117). Eachgroup was stratified into three post-reconstructive time periods:short-term (�� 5 years), intermediate (6-8 years), and long-term(�8 years).

RESULTS: Mean follow-up time after reconstruction was 6.5 years(range 1-18 years). Procedure type had no effect in the short-term.However, in the intermediate-term, TRAM patients were signifi-cantly more satisfied with their reconstructed breast shape, size, andsoftness (p values �.05). In addition, TRAM patients felt morestrongly that their outcome matched their expectations, that theywould recommend their type of reconstruction to others, and thatthey did not need more surgery to improve the appearance of theirbreasts (p values �.05). All of these differences remained significantat greater than 8 years post-reconstruction.

CONCLUSIONS: In the long-term, TRAM patients, compared toexpander/implant patients, appear to have significantly greater aes-thetic and decisional satisfaction. These long-term data have criticalimplications for women navigating the complex decision-makingprocess of breast reconstruction and for women’s health in the survi-vorship period.

Rural vs urban colorectal and lung cancer patients:Differences in stage at presentationIan M Paquette, MD, Samuel Finlayson, MD, MPH, FACSDartmouth-Hitchcock Medical Center, Lebanon, NH

INTRODUCTION: Rural surgeons are often uneasy when theiroutcomes are compared with those of urban surgeons becausethey perceive that rural patients typically present with more ad-vanced disease. The common assumption that rural patients withcancer present at later stages of disease is based largely on anec-dotal evidence.

METHODS: Retrospective analysis of cancer stage at presentation inrural vs. urban patients with two common cancers (lung, colorectal)using the Surveillance, Epidemiology, and End Results database fromthe National Cancer Institute. Rural vs. urban designations werebased on rural-urban continuum codes from the US Department ofAgriculture. Patient characteristics associated with late stage at pre-sentation were identified, and stage at presentation for rural vs. urbancancer patients was compared using an ordinal logistic regressionmodel.

RESULTS: For colon cancer, patient characteristics significantly as-sociated with stage 4 disease were low income, black race, age �65,divorce, male gender, and language isolation. For lung cancer, char-acteristics significantly associated with stage 4 disease were black race,divorce, male gender, and language isolation. Urban patients werefound to be more likely than rural patients to present with late stagecolorectal and lung cancer (p�0.001).

CONCLUSIONS: Urban rather than rural residence appears to beassociated with later stages of lung and colorectal cancer at pre-sentation. This study refutes the assumption that rural patients inthe US present at more advanced cancer stage compared to urbanpatients.

Race and insurance status predict presentationbut not outcomes in perforated appendicitis inchildrenMeghan A Arnold, MD, David C Chang, PhD, MPH, MBA,Paul M Colombani, MD, Fizan Abdullah, MD, PhDJohns Hopkins Medical Institutions, Baltimore, MD

INTRODUCTION: Health care outcomes are determined by a vari-ety of community- and hospital-level factors. In evaluating the qual-ity of pediatric surgical care, perforated appendicitis is one bench-mark as delays in treatment can result in worse morbidity. Althoughit is well known that race and insurance status affect presentation inappendicitis, our analysis shows that these factors play no further rolein the risk of in-hospital death.

METHODS: The NIS and KID databases (1988-2003) were used toidentify children (?18 years) with acute and perforated appendicitis.Outcome variables were presentation with appendicitis and deathafter perforation. Independent variables included age, race, gender,insurance status and hospital type.

RESULTS: A total of 295,963 children with appendicitis wereidentified, of whom 93,843 (31.7%) presented with perforation.Fifty-five (0.06%) died in the perforated group compared with 20(0.01%) in the non-perforated group (p�0.01). In multivariateanalysis, perforated appendicitis was associated with younger age,admission to an urban teaching hospital, Black race and lack ofhealth insurance. In-hospital death after perforation was not re-lated to race or insurance status, but was predicted by age andhospital type.

S79Vol. 205, No. 3S, September 2007 Surgical Forum Abstracts