High Social Vulnerability and “Textbook Outcomes” after Cancer Operation
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- 25 January 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 232 (4), 351-359
- https://doi.org/10.1016/j.jamcollsurg.2020.11.024
Abstract
Background The effect of community-level factors on surgical outcomes has not been well examined. We sought to characterize differences in “textbook outcomes” (TO) relative to social vulnerability among Medicare beneficiaries who underwent operations for cancer. Methods Individuals who underwent operations for lung, esophageal, colon, or rectal cancer between 2013 and 2017 were identified using the Medicare database, which was merged with the CDC's Social Vulnerability Index (SVI). TO was defined as surgical episodes with the absence of complications, extended length of stay, readmission, and mortality. The association of SVI and TO was assessed using mixed-effects logistic regression. Results Among 203,800 patients (colon, n = 113,929; lung, n = 70,642; rectal, n = 14,849; and esophageal, n = 4,380), median age was 75 years (interquartile range 70 to 80 years) and the overwhelming majority of patients was White (n = 184,989 [90.8%]). The overall incidence of TO was 56.1% (n = 114,393). The incidence of complications (low SVI: 21.5% vs high SVI: 24.0%) and 90-day mortality (low SVI: 7.0% vs high SVI: 8.4%) were higher among patients from highly vulnerable neighborhoods (both, p < 0.05). In turn, there were lower odds of achieving TO among high-vs low-SVI patients (odds ratio 0.83; 95% CI, 0.78 to 0.87). Although high-SVI White patients had 10% lower odds (95% CI, 0.87 to 0.93) of achieving TO, high-SVI non-White patients were at 22% lower odds (95% CI, 0.71 to 0.85) of postoperative TO. Compared with low-SVI White patients, high-SVI minority patients had 47% increased odds of an extended length of stay, 40% increased odds of a complication, and 23% increased odds of 90-day mortality (all, p < 0.05). Conclusions Only roughly one-half of Medicare beneficiaries achieved the composite optimal TO quality metric. Social vulnerability was associated with lower attainment of TO and an increased risk of adverse postoperative surgical outcomes after several common oncologic procedures. The effect of high SVI was most pronounced among minority patients.Keywords
This publication has 37 references indexed in Scilit:
- Association of Hospital Network Participation With Surgical Outcomes and Medicare ExpendituresAnnals of Surgery, 2019
- Patterns of readmission among the elderly after hepatopancreatobiliary surgeryThe American Journal of Surgery, 2018
- The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database AnalysisJournal of Gastrointestinal Surgery, 2018
- Textbook OutcomeAnnals of Surgery, 2017
- Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery.JAMA Surgery, 2017
- Incorporating Patients’ Social Determinants of Health into Hypertension and Depression Care: A Pilot Randomized Controlled TrialCommunity Mental Health Journal, 2017
- Racial Disparities in Operative Outcomes After Major Cancer Surgery in the United StatesWorld Journal of Surgery, 2014
- Trends in Racial Disparities in Pancreatic Cancer SurgeryJournal of Gastrointestinal Surgery, 2013
- Understanding the Social Factors That Contribute to Diabetes: A Means to Informing Health Care and Social Policies for the Chronically IllThe Permanente Journal, 2013
- Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 CountriesAmerican Journal of Epidemiology, 2011