Social vulnerability is associated with post-operative morbidity following robotic-assisted lung resection

Christina M Stuart; Adam R Dyas; Sara Byers; Catherine G Velopulos; Simran K Randhawa; Elizabeth A David; John D Mitchell; Robert A Meguid

doi:10.21037/jtd-23-1122

Social vulnerability is associated with post-operative morbidity following robotic-assisted lung resection

J Thorac Dis. 2023 Nov 30;15(11):5931-5941. doi: 10.21037/jtd-23-1122. Epub 2023 Oct 30.

Authors

Christina M Stuart^#^{1

2}, Adam R Dyas^#^{1

2}, Sara Byers^{2

3}, Catherine G Velopulos¹, Simran K Randhawa¹, Elizabeth A David¹, John D Mitchell¹, Robert A Meguid^{1

2

3}

Affiliations

¹ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
² Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
³ Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.

^# Contributed equally.

Abstract

Background: The social vulnerability index (SVI) is a neighborhood-based metric used to determine an individual's susceptibility to socioeconomic hardship, with high SVI indicating high susceptibility. SVI has previously been associated with surgical outcomes. We aimed to determine if SVI influences morbidity following robotic-assisted lung resection.

Methods: This was a retrospective cohort study at one academic medical center (1/1/2021-11/30/2022). Patients undergoing robotic-assisted lung resection were grouped into low (<75^th percentile) and high (≥75^th percentile) SVI cohorts. The primary outcome was 30-day overall morbidity; secondary outcomes were individual 30-day post-operative outcomes. Univariate analysis was performed using Chi-squared or Mann-Whitney-U tests, and multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) of postoperative complications.

Results: We included 320 patients, of which 40 patients (12.5%) in the high-SVI group and 280 (87.5%) in the low-SVI group. High SVI patients were more likely to be non-Caucasian and of Hispanic ethnicity, but there were no other differences in perioperative characteristics (all P>0.05). High SVI patients were more likely to experience a post-operative complication (42.5% vs. 24.6%, P=0.017), surgical site infection (SSI) (12.5% vs. 4.3%, P=0.047), hemothorax (5.0% vs. 0.0%, P=0.015), intensive care need (15.0% vs. 4.6%, P=0.021), sepsis (10.0% vs. 1.1%, P=0.006) and unplanned reoperation (5.0% vs. 0.4%, P=0.042). After risk-adjustment, the association of increased overall morbidity with high SVI persisted (OR =2.53; 95% confidence interval: 1.19-5.35).

Conclusions: High SVI was associated with increased risk-adjusted odds of morbidity after robotic-assisted lung resection. Highly vulnerable patients should be allocated perioperative resources to help mitigate the increased risk of these complications.

Keywords: Social vulnerability index (SVI); lung surgery; pulmonary resection; social determinants of health.