Socioeconomic disadvantage and pediatric surgical outcomes - 02/05/23

Doi : 10.1016/j.amjsurg.2023.02.002

Hannah Cockrell ^a,^b,^⁎ , Dwight Barry ^c, Andre Dick ^b,^d, Sarah Greenberg ^a,^b
^a Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
^b Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA, 98195, USA
^c Department of Clinical Analytics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
^d Division of Transplant Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

^∗Corresponding author. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.Division of Pediatric General and Thoracic SurgerySeattle Children's Hospital4800 Sand Point Way NESeattleWA98105USA

Abstract

Introduction

The impact of socioeconomic status on surgical outcomes has not been well-studied in children. Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage.

Methods

A retrospective analysis of surgical patients ages 0–21 years was performed at a quaternary pediatric hospital from 1/1/2016-12/31/2020. Logistic regression was used to assess the relationship between ADI, 30-day postoperative mortality and serious adverse events (SAE).

Results

Among 56,655 patients, the incidence of 30-day mortality and SAE were 0.3% and 8.9%. On univariable regression, patients from higher state ADI neighborhoods had increased odds of 30-day postoperative mortality and SAE. After controlling for covariates, patients from a neighborhood with state ADI ranks of 9 and 10 had 24% (95% CI: 1.06–1.45) and 27% (95% CI: 1.08–1.49) increased odds of experiencing SAE.

Discussion

Pediatric surgical patients from disadvantaged neighborhoods may experience worse postoperative outcomes irrespective of patient demographics and preoperative health status.

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Highlights

•	Neighborhood-level socioeconomic disadvantage is linked to worse health outcomes.
•	Area Deprivation Index is a validated measure of neighborhood disadvantage.
•	Children from high ADI neighborhoods experience increased postoperative morbidity.

Le texte complet de cet article est disponible en PDF.

Keywords : Pediatric surgery, Social determinants of health, Health equity

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Vol 225 - N° 5

P. 891-896 - mai 2023 Retour au numéro

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Socioeconomic disadvantage and pediatric surgical outcomes - 02/05/23

Abstract

Introduction

Methods

Results

Discussion

Highlights

Plan

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