Inequality in healthy lifespan after surgery: a longitudinal population study

BACKGROUND: The impact of surgery on long-term disease across socioeconomic groups is unknown. We investigated the onset of long-term disease after surgery and differences between socioeconomic and ethnic groups. METHODS: We conducted a longitudinal population study using linked primary and secondary care data, describing adults (≥18 yr) in England recorded in the Clinical Practice Research Datalink between January 1, 2012 and December 31, 2021. Socioeconomic deprivation was defined using the Index of Multiple Deprivation (IMD). The exposure was surgery, and the primary outcome was long-term disease. RESULTS: Of 18 329 659 people, 8 951 145 (48.8%) underwent surgery (elective: n=7 032 475 [78.6%]; emergency: n=1 918 670 [21.4%]). Of these, 4 741 188 (52.0%) were female, 3 540 136 (39.6%) were from the most deprived deciles (IMD 1-4), and 994 595 (11.1%) were from a minority ethnic group. Age-standardised surgery rates were higher among deprived individuals (comparative rate ratio, IMD 1 vs IMD 10, elective: 1.11 [95% CI 1.11-1.11]; emergency: 1.54 [95% CI 1.54-1.54]). Rates of long-term disease increased after elective (baseline 19.6%, 3-yr 24.5%) and emergency surgery (baseline 10.3%, 3-yr 12.3%). Risk of new long-term disease after surgery increased with increasing levels of deprivation (IMD 1 vs IMD 10, elective: hazard ratio [HR] 1.45 [95% CI 1.43-1.46]; emergency: HR 1.45 [95% CI 1.42-1.48]). CONCLUSIONS: Surgical treatment is strongly associated with the onset of long-term disease and factors that limit healthy life expectancy. Surgery occurs at a younger age among socioeconomically deprived groups and could be linked to health inequalities.