Diaz Adrian, Hyer J Madison, Tsilimigras Diamantis, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA; National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA.
Am J Surg. 2022 Feb;223(2):353-359. doi: 10.1016/j.amjsurg.2021.05.014. Epub 2021 Jun 1.
Social vulnerability is an important driver of disparate surgical outcomes, however the extent to which certain types of vulnerability impact outcomes is poorly understood.
Medicare beneficiaries 65 years or older who underwent one of four operations were identified. Multivariable mixed-effects logistic regression was used to measure the association of four social vulnerability subthemes from the social vulnerability index (SVI) were assessed relative to the likelihood to achieve a textbook outcome (TO).
Among 579,846 Medicare beneficiaries, median age was 74 years and most patients (536,455,92.5%) were White/non-Hispanic. On multivariable analysis, the overall impact of the composite SVI metric on the odds to achieve a postoperative TO was lower among White/non-Hispanic patients (Δ25%ile SVI:OR:0.98,95%CI:0.97-0.98) compared with ethnic/minority patients (Δ25%ile SVI:OR:0.93,95%CI:0.91-0.94). Increasing vulnerability in the subthemes of socioeconomic status (Δ25%ile SVI:ethnic/minority:OR:0.92, 95%CI:0.91-0.94) and household composition (Δ25%ile SVI:ethnic/minority:OR:0.92,95%CI:0.91-0.94) was associated with a greater likelihood not to achieve a TO among minority patients.
Worsening SES and household compositions & disability had a detrimental effect on odds of TO following surgery with the most pronounced effect on non-White minority patients.
社会脆弱性是导致手术结果存在差异的一个重要因素，然而，人们对某些类型的脆弱性对手术结果的影响程度却知之甚少。
确定了65岁及以上接受四种手术之一的医疗保险受益人。采用多变量混合效应逻辑回归来衡量社会脆弱性指数（SVI）中的四个社会脆弱性子主题与实现教科书式结果（TO）可能性之间的关联。
在579,846名医疗保险受益人中，中位年龄为74岁，大多数患者（536,455名，92.5%）为白人/非西班牙裔。在多变量分析中，与少数族裔患者相比，综合SVI指标对白人/非西班牙裔患者实现术后TO几率的总体影响较低（SVI第25百分位数变化：比值比：0.98，95%置信区间：0.97 - 0.98）（SVI第25百分位数变化：少数族裔：比值比：0.93，95%置信区间：0.91 - 0.94）。社会经济地位（SVI第25百分位数变化：少数族裔：比值比：0.92，95%置信区间：0.91 - 0.94）和家庭构成（SVI第25百分位数变化：少数族裔：比值比：0.92，95%置信区间：0.91 - 0.94）子主题中脆弱性的增加与少数族裔患者更有可能无法实现TO相关。
社会经济地位、家庭构成及残疾状况的恶化对手术后实现TO的几率有不利影响，对非白人少数族裔患者的影响最为显著。
