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Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Authors :
David Reines
Robert B. Hawkins
J. Hunter Mehaffey
Sandy Fogel
Gorav Ailawadi
Peter T. Hallowell
Eric J. Charles
Florence E. Turrentine
Brian J. Kaplan
John B. Hanks
Charles T. Harris
Jorge Posadas
R. Scott Jones
Source :
BMJ qualitysafety. 29(3)
Publication Year :
2019

Abstract

BackgroundSocioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.MethodsAll patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.ResultsA total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, pConclusionIncreasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.

Details

ISSN :
20445423
Volume :
29
Issue :
3
Database :
OpenAIRE
Journal :
BMJ qualitysafety
Accession number :
edsair.doi.dedup.....690fb115d4d8d46e40a4c7db3d155159