Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries.

Szczegóły
Abstrakt

Tytuł:: Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries.
Autorzy:: Zhang Y; From the National Clinician Scholars Program at the Clinical Research Training Program, Duke University, Durham, NC (Zhang).; Department of Surgery, Yale University, New Haven, CT (Zhang).
Kunnath N; Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.
Dimick JB; Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.
Scott JW; Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI.
Ibrahim AM; Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.
Źródło:: Journal of the American College of Surgeons [J Am Coll Surg] 2023 Jan 01; Vol. 236 (1), pp. 208-217. Date of Electronic Publication: 2022 Dec 15.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2022- : [Baltimore, MD] : Lippincott Williams & Wilkins, Inc.
Original Publication: Chicago, Ill. : The College, c1994-
MeSH Terms:: Medicare*
Social Vulnerability*
Humans ; Aged ; United States/epidemiology ; Cross-Sectional Studies ; Hospitals ; Cholecystectomy
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Grant Information:: R01 AG039434 United States AG NIA NIH HHS; R01 DK131584 United States DK NIDDK NIH HHS; R01 HS028606 United States HS AHRQ HHS
Entry Date(s):: Date Created: 20221215 Date Completed: 20221219 Latest Revision: 20240102
Update Code:: 20240102
PubMed Central ID:: PMC9764237
DOI:: 10.1097/XCS.0000000000000429
PMID:: 36519918
: Czasopismo naukowe

Background: Although the Social Vulnerability Index (SVI) was created to identify vulnerable populations after unexpected natural disasters, its ability to identify similar groups of patients undergoing unexpected emergency surgical procedures is unknown. We sought to examine the association between SVI and outcomes after emergency general surgery.
Study Design: This study is a cross-sectional review of 887,193 Medicare beneficiaries who underwent 1 of 4 common emergency general surgery procedures (appendectomy, cholecystectomy, colectomy, and ventral hernia repair) performed in the urgent or emergent setting between 2014 and 2018. These data were merged with the SVI at the census-track level of residence. Risk-adjusted outcomes (30-day mortality, serious complications, readmission) were evaluated using a logistic regression model accounting for age, sex, comorbidity, year, procedure type, and hospital characteristics between high and low social vulnerability quintiles and within the 4 SVI subthemes (socioeconomic status; household composition and disability; minority status and language; and housing type and transportation).
Results: Compared with beneficiaries with low social vulnerability, Medicare beneficiaries living in areas of high social vulnerability experienced higher rates of 30-day mortality (8.56% vs 8.08%; adjusted odds ratio 1.07; p < 0.001), serious complications (20.71% vs 18.40%; adjusted odds ratio 1.17; p < 0.001), and readmissions (16.09% vs 15.03%; adjusted odds ratio 1.08; p < 0.001). This pattern of differential outcomes was present in subgroup analysis of all 4 SVI subthemes but was greatest in the socioeconomic status and household composition and disability subthemes.
Conclusions: National efforts to support patients with high social vulnerability from natural disasters may be well aligned with efforts to identify communities that are particularly vulnerable to worse postoperative outcomes after emergency general surgery. Policies targeting structural barriers related to household composition and socioeconomic status may help alleviate these disparities.
(Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

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