Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Surgery, University of Virginia Health, Charlottesville, VA.
Surgery. 2021 Nov;170(5):1495-1500. doi: 10.1016/j.surg.2021.02.016. Epub 2021 Mar 12.
There is a strong association between socioeconomic status and surgical outcomes; however, the optimal method for socioeconomic risk-stratification remains elusive. We aimed to compare 2 metrics of socioeconomic ranking by ZIP code, the Distressed Communities Index, and the Area Deprivation Index and their association with surgical outcomes.
This retrospective study included all general surgery cases performed at a single institution from 2005 to 2015. Each patient was assigned Distressed Communities Index and Area Deprivation Index scores based on ZIP code. Both indices are normalized composite measures of socioeconomic status derived from census data. Primary outcome was 30-day morbidity; secondary outcomes included long-term mortality and cost, stratified by socioeconomic status. The utility of the addition of each metric to the American College of Surgeons National Surgical Quality Improvement Program risk calculator was assessed.
The 9,843 patients had normally distributed Distressed Communities Index (47.3 ± 22.4) and Area Deprivation Index (35.4 ± 19.0). Patients who experienced any complication or readmission had significantly higher Distressed Communities Index (48.6 vs 47.1, P = .04) and Area Deprivation Index (37.2 vs 35.1, P = .002). Risk-adjusted models demonstrated that only Area Deprivation Index independently predicted postoperative complications (odds ratio 1.11, P = .02), improved the discrimination of risk-stratification when added to the American College of Surgeons National Surgical Quality Improvement Program risk calculator (area under curve 0.758-0.790, P = .02), and was associated with hospitalization cost ($1,811 ± 856/quartile, P = .03).
Area Deprivation Index provides improved socioeconomic risk-adjustment in this surgical population. The addition of Area Deprivation Index to risk-stratification tools would allow us to better inform our patients of their expected postoperative courses, more accurately account for the increased cost of providing their care, and identify patients and regions that are most in need of improvements in health and healthcare.
社会经济地位与手术结果之间存在很强的关联；然而，用于社会经济风险分层的最佳方法仍然难以捉摸。我们旨在比较邮政编码的两种社会经济排名指标，即贫困社区指数和区域贫困指数，及其与手术结果的关系。
这项回顾性研究包括 2005 年至 2015 年在一家机构进行的所有普外科手术。根据邮政编码为每位患者分配贫困社区指数和区域贫困指数评分。这两个指数都是基于人口普查数据得出的社会经济地位的标准化综合衡量标准。主要结果是 30 天发病率；次要结果包括按社会经济地位分层的长期死亡率和成本。评估了每个指标添加到美国外科医师学会国家手术质量改进计划风险计算器中的效果。
9843 例患者的贫困社区指数（47.3±22.4）和区域贫困指数（35.4±19.0）呈正态分布。发生任何并发症或再入院的患者贫困社区指数（48.6 比 47.1，P=0.04）和区域贫困指数（37.2 比 35.1，P=0.002）明显更高。风险调整模型表明，只有区域贫困指数独立预测术后并发症（优势比 1.11，P=0.02），当添加到美国外科医师学会国家手术质量改进计划风险计算器中时提高了风险分层的区分能力（曲线下面积 0.758-0.790，P=0.02），并且与住院费用相关（每个四分位数增加 1811±856 美元，P=0.03）。
区域贫困指数为该手术人群提供了更好的社会经济风险调整。将区域贫困指数添加到风险分层工具中，可以让我们更好地告知患者他们预期的术后过程，更准确地计算提供护理的成本增加，以及确定最需要改善健康和医疗保健的患者和地区。
