Williamson Catherine G, Richardson Shannon, Ebrahimian Shayan, Kronen Elsa, Verma Arjun, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Surg Open Sci. 2023 Apr 15;13:66-70. doi: 10.1016/j.sopen.2023.04.001. eCollection 2023 Jun.
While the impact of socioeconomic status (SES) on surgical outcomes has been examined in limited series, it remains a significant determinant of healthcare outcomes at the national level. Therefore, the current study aims to determine SES disparities at three time-points: hospital accessibility, in-hospital outcomes, and post-discharge consequences.
The Nationwide Readmissions Database 2010-2018 was used to isolate major elective operations. SES was assigned using previously coded median income quartiles as defined by patient zip-code, with defined as the lowest quartile and as the highest.
Of an estimated 4,816,837 patients undergoing major elective operations, 1,037,689 (21.3 %) were categorized as and 1,288,618 (26.5 %) as . On univariate analysis and compared to those of patients were more frequently treated at high-volume centers (70.9 vs 55.6 %, p < 0.001), had lower rates of in-hospital complications (24.0 vs 29.0 %, p < 0.001) and mortality (0.4 vs 0.9 %, p < 0.001) as well as less frequent urgent readmissions at 30- (5.7 vs 7.1 %, p < 0.001) and 90-day timepoints (9.4 vs 10.7 %, p < 0.001). On multivariable analysis, patients had higher odds of treatment at high-volume centers (Odds: 1.87, 95 % CI: 1.71-2.06), and lower odds of perioperative complications (Odds: 0.98, 95 % CI: 0.96-0.99), mortality (Odds: 0.70, 95 % CI: 0.65-0.75), and urgent readmissions at 90-days (Odds: 0.95, 95 % CI: 0.92-0.98).
This study fills a much-needed gap in the current literature by establishing that all of the aforementioned timepoints include significant disadvantages for those of low socioeconomic status. Therefore, a multidisciplinary approach may be required for intervention to improve equity for surgical patients.
虽然社会经济地位（SES）对外科手术结果的影响在有限的系列研究中已被探讨，但在国家层面，它仍是医疗保健结果的一个重要决定因素。因此，本研究旨在确定在三个时间点上的SES差异：医院可及性、住院期间结果和出院后后果。
使用2010 - 2018年全国再入院数据库来筛选主要的择期手术。SES根据患者邮政编码预先编码的收入中位数四分位数来划分，最低四分位数定义为Q1，最高四分位数定义为Q4。
在估计的4,816,837例接受主要择期手术的患者中，1,037,689例（21.3%）被归类为Q1，1,288,618例（26.5%）被归类为Q4。单因素分析显示，与Q4患者相比，Q1患者在高容量中心接受治疗的频率更高（70.9%对55.6%，p < 0.001），住院并发症发生率更低（24.0%对29.0%，p < 0.001），死亡率更低（0.4%对0.9%，p < 0.001），以及在30天（5.7%对7.1%，p < 0.001）和90天时间点的紧急再入院频率更低（9.4%对10.7%，p < 0.001）。多因素分析显示，Q1患者在高容量中心接受治疗的几率更高（几率：1.87，95%置信区间：1.71 - 2.06），围手术期并发症几率更低（几率：0.98，95%置信区间：0.96 - 0.99），死亡率更低（几率：0.70，95%置信区间：0.65 - 0.75），以及90天紧急再入院几率更低（几率：0.95，95%置信区间：0.92 - 0.98）。
本研究通过证实上述所有时间点对于社会经济地位较低者都存在显著劣势，填补了当前文献中急需的空白。因此，可能需要一种多学科方法进行干预，以改善外科患者的公平性。
