Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population

Adam R Dyas; Heather Carmichael; Michael R Bronsert; Christina M Stuart; Denise M Garofalo; William G Henderson; Kathryn L Colborn; Richard D Schulick; Robert A Meguid; Catherine G Velopulos

doi:10.1016/j.amjsurg.2023.09.028

Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population

Am J Surg. 2024 Mar:229:26-33. doi: 10.1016/j.amjsurg.2023.09.028. Epub 2023 Sep 23.

Affiliations

¹ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
² Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
³ Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
⁴ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: christina.stuart@cuanschutz.edu.
⁵ Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

PMID: 37775458
DOI: 10.1016/j.amjsurg.2023.09.028

Abstract

Objective: The purpose of this study was to determine if an association between Social Vulnerability Index (SVI) and risk-adjusted complications exists in a broad spectrum of surgical patients.

Summary background data: Growing evidence supports the impact of social circumstances on surgical outcomes. SVI is a neighborhood-based measure accounting for sociodemographic factors putting communities at risk.

Methods: This was a multi-hospital, retrospective cohort study including a sample of patients within one healthcare system (2012-2017). Patient addresses were geocoded to determine census tract of residence and estimate SVI. Patients were grouped into low SVI (score<75) and high SVI (score≥75) cohorts. Perioperative variables and postoperative outcomes were tracked and compared using local ACS-NSQIP data. Multivariable logistic regression was performed to generate risk-adjusted odds ratios of postoperative complications in the high SVI cohort.

Results: Overall, 31,224 patients from five hospitals were included. Patients with high SVI were more likely to be racial minorities, have 12/18 medical comorbidities, have high ASA class, be functionally dependent, be treated at academic hospitals, and undergo emergency operations (all p < 0.05). Patients with high SVI had significantly higher rates of 30-day mortality, overall morbidity, respiratory, cardiac and infectious complications, urinary tract infections, postoperative bleeding, non-home discharge, and unplanned readmissions (all p < 0.05). After risk-adjustment, only the associations between high SVI and mortality and unplanned readmission became non-significant.

Conclusions: High SVI was associated with multiple adverse outcomes even after risk adjustment for preoperative clinical factors. Targeted preventative interventions to mitigate risk of these specific complications should be considered in this high-risk population.

Keywords: Health disparity; National surgical quality improvement program; Risk modeling; Social determinants of health; Social vulnerability.

MeSH terms

Humans
Postoperative Complications / etiology
Postoperative Hemorrhage
Quality Improvement*
Retrospective Studies
Social Vulnerability*