Understanding the impact of socioeconomic deprivation on inpatient surgical care delivery costs in the Veterans Health Administration

The impact of living in high neighborhood-level socioeconomic deprivation on inpatient surgery cost is not well known. This retrospective cohort study examines the relationship between the Area Deprivation Index (ADI) and non-cardiac inpatient surgery costs in the Veterans Health Administration (VHA). Patients aged ≥65 years undergoing non-cardiac inpatient surgery during 2013-2019 were identified in Veterans Affairs Surgical Quality Improvement Program (VASQIP) data linked to additional VHA data sources. The cohort includes 136, 631 predominantly male (97. 7%) individuals with mean (SD) age of 72 (6. 5) years. The 20, 462 individuals with high ADI (>85) were more often Black race (27% vs 13. 6%) with higher comorbidity burden (Gagne score 3. 4 vs 3. 1), higher frailty (29. 1 vs 28. 7), and more likely presenting with preoperative acute serious conditions (5. 6% vs 4. 5%) for more urgent (21. 3% vs 18. 7%) or emergent surgery (8. 9% vs 8. 1%, all p 85. Using unconditional quantile regression, costs were even higher (>1600) for patients with ADI>85 at or above the 75th cost quantile. The higher costs among individuals living in high ADI areas were attenuated after controlling for comorbidity and frailty (mean cost difference of -8; 95% CI: -312, 296; p = 0. 96 after adjustment for those factors) and presentation acuity (-57; 95% CI: -356, 241; p = 0. 71). Among older patients undergoing inpatient surgery in the VHA, ADI>85 is associated with higher surgical cost, an effect which is eliminated by controlling for patient comorbidity, frailty, and presentation acuity. These results suggest potential for cost-savings by mitigating barriers to healthcare access, timely surgery access, and other downstream effects of high neighborhood-level socioeconomic deprivation before surgery becomes urgent. • Surgical cost is associated with neighborhood-level socioeconomic deprivation. • High deprivation, measured by the Area Deprivation Index (ADI), is defined as ADI>85. • Veterans Health Administration inpatient surgery cost was 988 higher in ADI>85. • Higher cost is partially explained by comorbidity, frailty, and presentation acuity. • Mitigating barriers to healthcare access can impact health and downstream surgical cost.