Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA. Electronic address: https://twitter.com/sarasakowitz.
Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO.
Surgery. 2024 Aug;176(2):406-413. doi: 10.1016/j.surg.2024.03.044. Epub 2024 May 24.
Social determinants of health are increasingly recognized to shape health outcomes. Yet, the effect of socioeconomic vulnerability on outcomes after emergency general surgery remains under-studied.
All adult (≥18 years) hospitalizations for emergency general surgery operations (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of non-elective admission were tabulated in the 2016 to 2020 Nationwide Readmissions Database. Socioeconomic vulnerability was defined using relevant diagnosis codes and comprised economic, educational, healthcare, environmental, and social needs. Patients demonstrating socioeconomic vulnerability were considered Vulnerable (others: Non-Vulnerable). Multivariable models were constructed to evaluate the independent associations between socioeconomic vulnerability and key outcomes.
Of ∼1,788,942 patients, 177,764 (9.9%) were considered Vulnerable. Compared to Non-Vulnerable, Vulnerable patients were older (67 [55-77] vs 58 years [41-70), P < .001), more often insured by Medicaid (16.4 vs 12.7%, P < .001), and had a higher Elixhauser Comorbidity Index (4 [3-5] vs 2 [1-3], P < .001). After risk adjustment and with Non-Vulnerable as a reference, Vulnerable remained linked with a greater likelihood of in-hospital mortality (adjusted odds ratio 1.64, confidence interval 1.58-1.70) and any perioperative complication (adjusted odds ratio 2.02, confidence interval 1.98-2.06). Vulnerable also experienced a greater duration of stay (β+4.64 days, confidence interval +4.54-4.74) and hospitalization costs (β+$1,360, confidence interval +980-1,740). Further, the Vulnerable cohort demonstrated increased odds of non-home discharge (adjusted odds ratio 2.44, confidence interval 2.38-2.50) and non-elective readmission within 30 days of discharge (adjusted odds ratio 1.29, confidence interval 1.26-1.32).
Socioeconomic vulnerability is independently associated with greater morbidity, resource use, and readmission after emergency general surgery. Novel interventions are needed to build hospital screening and care pathways to improve disparities in outcomes.
越来越多的人认识到社会决定因素对健康结果有影响。然而，社会经济脆弱性对急诊普通外科手术后结果的影响仍研究不足。
在 2016 年至 2020 年全国再入院数据库中，统计了所有（≥18 岁）接受急诊普通外科手术（阑尾切除术、胆囊切除术、剖腹术、大肠切除术、穿孔性溃疡修复术或小肠切除术）的非择期入院后 2 天内的成人住院患者。社会经济脆弱性使用相关诊断代码定义，包括经济、教育、医疗保健、环境和社会需求。表现出社会经济脆弱性的患者被认为是脆弱的（其他：非脆弱的）。构建多变量模型以评估社会经济脆弱性与关键结果之间的独立关联。
在约 1788942 名患者中，有 177764 名（9.9%）被认为是脆弱的。与非脆弱患者相比，脆弱患者年龄更大（67[55-77]岁与 58 岁[41-70 岁]，P<0.001），更多地由医疗补助保险承保（16.4%与 12.7%，P<0.001），并且 Elixhauser 合并症指数更高（4[3-5]与 2[1-3]，P<0.001）。在风险调整后，以非脆弱为参考，脆弱仍然与更高的院内死亡率（调整后的优势比 1.64，置信区间 1.58-1.70）和任何围手术期并发症（调整后的优势比 2.02，置信区间 1.98-2.06）相关。脆弱患者的住院时间（β+4.64 天，置信区间+4.54-4.74）和住院费用（β+$1360，置信区间+980-1740）也更高。此外，脆弱组出院非家庭出院（调整后的优势比 2.44，置信区间 2.38-2.50）和出院后 30 天内非择期再入院（调整后的优势比 1.29，置信区间 1.26-1.32）的几率也更高。
社会经济脆弱性与急诊普通外科手术后更高的发病率、资源利用和再入院率独立相关。需要新的干预措施来建立医院筛查和护理途径，以改善结果的差异。
