Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
J Gastrointest Surg. 2021 Mar;25(3):786-794. doi: 10.1007/s11605-020-04768-3. Epub 2020 Aug 10.
A person's community, or lived environment, may play an important role in achieving optimal health outcomes. The objective of the current study was to assess the association of county-level vulnerability with the probability of having a non-elective colon resection. We hypothesized that individuals from areas with a high social vulnerability would be at greater risk of non-elective colon resection compared with patients from low social vulnerability areas.
Patients aged 65-99 who underwent a colon resection for a primary diagnosis of either diverticulitis (n = 11,812) or colon cancer (n = 33,312) were identified in Medicare Part A and Part B for years 2016-2017. Logistic regression analysis was used to evaluate differences in probability of undergoing an elective versus non-elective operation from counties relative to county-level social vulnerability index (SVI). Secondary outcomes included postoperative complications, mortality, readmission, and index hospitalization expenditure.
Among 45,124 patients, 11,812 (26.2%) underwent a colon resection for diverticulitis, while 33,312 (73.8%) had a resection for colon cancer; 31,012 (68.7%) patients had an elective procedure (diverticulitis n = 7291 (61.7%) vs. cancer n = 23,721 (71.2%)), while 14,112 (31.3%) had an emergent operation (diverticulitis n = 4521 (38.3%) vs. cancer n = 9591 (28.8%)). Patients with a high SVI were more likely to undergo an emergent colon operation compared with low SVI patients (43.7% vs. 40.4%) (p < 0.001). The association of high SVI with increased risk of an emergent colon operation was similar among patients with diverticulitis (emergent: low SVI 37.2% vs. high SVI 40.4%) or colon cancer (emergent: low SVI 26.0% vs. high SVI 29.9%) (both p < 0.05). On multivariable analyses, risk-adjusted probability of undergoing an urgent/emergent operation remained associated with SVI (p < 0.05).
Patients residing in vulnerable communities characterized by a high SVI were more likely to undergo a non-elective colon resection for either diverticulitis or colon cancer. Patients from high SVI areas had a higher risk of postoperative complications, as well as index hospitalization expenditures; however, there were no differences in mortality or readmission rates.
一个人的社区或居住环境可能对实现最佳健康结果起着重要作用。本研究的目的是评估县级脆弱性与非择期结肠切除术概率之间的关联。我们假设，与来自低社会脆弱性地区的患者相比，来自高社会脆弱性地区的个体更有可能接受非择期结肠切除术。
在 2016 年至 2017 年期间，从医疗保险 A 部分和 B 部分中确定了 65-99 岁接受原发性憩室炎（n=11812）或结肠癌（n=33312）结肠切除术的患者。使用逻辑回归分析评估了与县级社会脆弱性指数（SVI）相比，来自县的选择性与非选择性手术概率的差异。次要结局包括术后并发症、死亡率、再入院和指数住院支出。
在 45124 名患者中，有 11812 名（26.2%）因憩室炎接受结肠切除术，33312 名（73.8%）因结肠癌接受结肠切除术；31012 名（68.7%）患者接受了择期手术（憩室炎 n=7291（61.7%）vs.癌症 n=23721（71.2%）），14112 名（31.3%）患者接受了紧急手术（憩室炎 n=4521（38.3%）vs.癌症 n=9591（28.8%））。与低 SVI 患者相比，高 SVI 患者更有可能接受紧急结肠手术（43.7%比 40.4%）（p<0.001）。高 SVI 与紧急结肠手术风险增加之间的关联在憩室炎（紧急：低 SVI 37.2%比高 SVI 40.4%）或结肠癌（紧急：低 SVI 26.0%比高 SVI 29.9%）患者中相似（均为 p<0.05）。多变量分析显示，风险调整后紧急/紧急手术的概率与 SVI 相关（p<0.05）。
居住在以高 SVI 为特征的脆弱社区的患者更有可能因憩室炎或结肠癌而接受非择期结肠切除术。来自高 SVI 地区的患者术后并发症发生率以及指数住院费用较高；然而，死亡率或再入院率没有差异。
