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September 20, 2019BMJ Quality & Safety

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

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Key result

Living in a severely distressed community was independently associated with increased postoperative complications (9.8% vs 8.5%; OR 1.07, 95% CI 1.04-1.10; p<0.0001) and resource utilization.

Why the study?

Socioeconomic status affects surgical outcomes, but these factors are not included in clinical quality improvement data and risk models.

Does severe community distress (DCI >75) increase postoperative complications and resource utilisation in patients undergoing surgery?

Population

44,451 surgical patients in a regional ACS-NSQIP registry

Comparison

Top quartile of distress (DCI >75) vs remainder of cohort

Design

Prospective registry analysis

Authors

JMJ. Hunter MehaffeyRHRobert B. HawkinsECEric J. Charles

Discussion

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Overview

May enhance preoperative risk models; leaves open whether community interventions reduce disparities.

Key Points

  • This research aims to evaluate the impact of socioeconomic status, measured by the Distressed Communities Index, on surgical outcomes and resource utilization.
  • Conducted a prospective registry analysis with 44,451 surgical patients from the ACS-NSQIP database.
  • Paired patients' outcomes with their Distressed Communities Index (DCI) rankings.
  • Used mixed effects modeling to assess the association between DCI and surgical complications, adjusting for risk factors.
  • Patients from severely distressed communities had higher rates of postoperative complications (9.8% vs 8.5%, p<0.0001).
  • Increased 30-day mortality was observed in those with DCI >75 (1.8% vs 1.4%, p=0.01).
  • DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001).

Study Design

Type

Cohort (n=44,451)

Multicenter

Yes

Structured PICO

Does severe community distress (DCI >75) increase postoperative complications and resource utilisation in patients undergoing surgery?

P
Population
44,451 patients undergoing surgery in a regional quality improvement database, evaluated for 30-day postoperative outcomes based on community socioeconomic distress.
E
Exposure
Severely distressed communities (Distressed Communities Index [DCI] >75, top quartile)
C
Comparator
Remainder of the cohort (DCI ≤75)
O
Outcome
Surgical complications and resource utilisationhard clinical

Main Result

Odds Ratio: 1.07 (95% CI 1.04–1.1)

Absolute Event Rate: 9.8% vs 8.5%

p-value: p=<0.0001

Community-level socioeconomic distress is independently associated with increased postoperative complications and resource utilization, highlighting disparities not captured by standard clinical risk models.

Cite This Study

Mehaffey et al. (2019) conducted a cohort in Patients undergoing surgery (n=44,451). Severely distressed communities (DCI >75) vs. Remainder of the cohort (lower distress) was evaluated on Postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p=<0.0001). Living in a severely distressed community was independently associated with increased postoperative complications (9.8% vs 8.5%; OR 1.07, 95% CI 1.04-1.10; p<0.0001) and resource utilization.

synapsesocial.com/papers/6a21189701cd1e967e1e471bhttps://doi.org/10.1136/bmjqs-2019-009800
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