Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX. Electronic address: https://twitter.com/ReaganACollins.
Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX.
Surgery. 2024 Feb;175(2):457-462. doi: 10.1016/j.surg.2023.10.026. Epub 2023 Nov 27.
The effect of social health determinants on hernia surgery receipt is unclear. We aimed to assess the association of the social vulnerability index with the likelihood of undergoing elective and emergency hernia repair in Texas.
This is a retrospective cohort analysis of the Texas Hospital Inpatient Discharge Public Use Data File and Texas Outpatient Surgical and Radiological Procedure Public Use Data File from 2016 to 2019. Patients ≥18 years old with inguinal or umbilical hernia were included. Social vulnerability index and urban/rural status were merged with the database at the county level. Patients were stratified based on social vulnerability index quartiles, with the lowest quartile (Q1) designated as low vulnerability, Q2 and Q3 as average, and Q4 as high vulnerability. Wilcoxon rank sum, t test, and χ analysis were used, as appropriate. The relative risk of undergoing surgery was calculated with subgroup sensitivity analysis.
Of 234,843 patients assessed, 148,139 (63.1%) underwent surgery. Compared to patients with an average social vulnerability index, the low social vulnerability index group was 36% more likely to receive surgery (relative risk: 1.36, 95% CI 1.34-1.37), whereas the high social vulnerability index group was 14% less likely to receive surgery (relative risk: 0.86, 95% CI 0.85-0.86). This remained significant after stratifying for age, sex, insurance status, ethnicity, and urban/rural status (P < .05). For emergency admissions, there was no difference in receipt of surgery by social vulnerability index.
Vulnerable patients are less likely to undergo elective surgical hernia repair, even after adjusting for demographics, insurance, and urbanicity. The social vulnerability index may be a useful indicator of social determinants of health barriers to hernia repair.
社会健康决定因素对疝手术接受率的影响尚不清楚。本研究旨在评估德克萨斯州社会脆弱性指数与接受择期和急诊疝修复的可能性之间的关联。
这是一项对 2016 年至 2019 年德克萨斯州住院患者出院公共使用数据集和德克萨斯州门诊手术和放射程序公共使用数据集的回顾性队列分析。纳入年龄≥18 岁的腹股沟或脐疝患者。社会脆弱性指数和城乡状况与数据库在县一级合并。根据社会脆弱性指数四分位数对患者进行分层，最低四分位数（Q1）定义为低脆弱性，Q2 和 Q3 为平均，Q4 为高脆弱性。适当使用 Wilcoxon 秩和检验、t 检验和卡方检验。使用亚组敏感性分析计算手术的相对风险。
在评估的 234843 名患者中，148139 名（63.1%）接受了手术。与社会脆弱性指数平均的患者相比，低社会脆弱性指数组接受手术的可能性高 36%（相对风险：1.36，95%CI 1.34-1.37），而高社会脆弱性指数组接受手术的可能性低 14%（相对风险：0.86，95%CI 0.85-0.86）。在按年龄、性别、保险状况、种族和城乡状况分层后，这仍然具有统计学意义（P<0.05）。对于急诊入院，社会脆弱性指数对手术接受率没有影响。
脆弱患者接受择期疝手术修复的可能性较低，即使在调整人口统计学、保险和城市状况后也是如此。社会脆弱性指数可能是疝修复健康障碍社会决定因素的有用指标。
