Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population - 26/02/24

Doi : 10.1016/j.amjsurg.2023.09.028

Adam R. Dyas ^a,^b,^{^{1
Denotes co-first authors.}}, Heather Carmichael ^a,^{^{1
Denotes co-first authors.}}, Michael R. Bronsert ^b, Christina M. Stuart ^a,^b,^⁎ , Denise M. Garofalo ^a,^b, William G. Henderson ^a,^b, Kathryn L. Colborn ^c,^d, Richard D. Schulick ^a,^b, Robert A. Meguid ^a,^b, Catherine G. Velopulos ^a,^b
^a Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
^b Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
^c Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
^d Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

^∗Corresponding author. University of Colorado School of Medicine, 12631 E. 17th Avenue #6117, Aurora, CO, 80045, USA.University of Colorado School of Medicine12631 E. 17th Avenue #6117AuroraCO80045USA

Abstract

Objective

The purpose of this study was to determine if an association between Social Vulnerability Index (SVI) and risk-adjusted complications exists in a broad spectrum of surgical patients.

Summary background data

Growing evidence supports the impact of social circumstances on surgical outcomes. SVI is a neighborhood-based measure accounting for sociodemographic factors putting communities at risk.

Methods

This was a multi-hospital, retrospective cohort study including a sample of patients within one healthcare system (2012–2017). Patient addresses were geocoded to determine census tract of residence and estimate SVI. Patients were grouped into low SVI (score<75) and high SVI (score≥75) cohorts. Perioperative variables and postoperative outcomes were tracked and compared using local ACS-NSQIP data. Multivariable logistic regression was performed to generate risk-adjusted odds ratios of postoperative complications in the high SVI cohort.

Results

Overall, 31,224 patients from five hospitals were included. Patients with high SVI were more likely to be racial minorities, have 12/18 medical comorbidities, have high ASA class, be functionally dependent, be treated at academic hospitals, and undergo emergency operations (all p < 0.05). Patients with high SVI had significantly higher rates of 30-day mortality, overall morbidity, respiratory, cardiac and infectious complications, urinary tract infections, postoperative bleeding, non-home discharge, and unplanned readmissions (all p < 0.05). After risk-adjustment, only the associations between high SVI and mortality and unplanned readmission became non-significant.

Conclusions

High SVI was associated with multiple adverse outcomes even after risk adjustment for preoperative clinical factors. Targeted preventative interventions to mitigate risk of these specific complications should be considered in this high-risk population.

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Highlights

•	The Social Vulnerability Index (SVI) accounts for sociodemographic factors putting communities at risk.
•	Increased SVI is associated with increased risk-adjusted rates of postoperative complications.
•	Targeted interventions to risk-mitigate these complications should be considered in this high-risk population.

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Résumé

We used local ACS-NSQIP data from one healthcare system comprised of five hospitals to determine the association between SVI and postoperative complications. Socially vulnerable patients had higher risk-adjusted rates of several postoperative complications. Targeted interventions to mitigate the risk of these complications should be considered for this vulnerable population.

Le texte complet de cet article est disponible en PDF.

Keywords : Social vulnerability, Health disparity, Risk modeling, National surgical quality improvement program, Social determinants of health