Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Surgery. 2024 Oct;176(4):1131-1137. doi: 10.1016/j.surg.2024.06.019. Epub 2024 Jul 16.
Patients from low socioeconomic backgrounds have greater rates of morbidity and mortality across disease processes. The Distressed Communities Index identified several socioeconomic components that were used to create a Distressed Communities Index score for every ZIP code, then broken into quintiles from prosperous to distressed. We aimed to explore whether socioeconomic distress as defined by the Distressed Communities Index affects the outcome of complex ventral hernia repair in the elderly population.
Retrospective analysis was performed using the Abdominal Core Health Collaborative data. Included were adults aged 65+ years undergoing elective complex ventral hernia repair from 2013 to 2021. Primary outcomes were postoperative outcomes and composite hernia recurrence by Distressed Communities Index quintile. The Cox proportional hazards model was used for composite recurrence, and logistic regression was used for postoperative outcomes.
A total of 4,172 patients were included. Patients in distressed communities were more likely to identify as female or racial minority and had greater body mass index and American Society of Anesthesiologists class. Lower Distressed Communities Index quintile was associated with larger hernia (P = .012), open repair (P = .019), and 30-day complication (P = .05). There was no association between time to recurrence and Distressed Communities Index quintile (P = .24). After adjusted analysis, there was no significant difference for readmission, reoperation, recurrence, and complications.
Patients from more distressed communities presented in worse clinical status with larger hernias. This likely contributed to greater rates of open repair and complications. However, when adjusted for these variables, outcomes were similar across Distressed Communities Index quintile. This supports the efficacy of complex hernia repair across socioeconomic classes.
在各种疾病过程中，社会经济背景较低的患者发病率和死亡率更高。困境社区指数确定了几个社会经济组成部分，用于为每个邮政编码创建困境社区指数得分，然后从繁荣到困境分为五等分。我们旨在探讨困境社区指数定义的社会经济困境是否会影响老年人群体复杂腹疝修复的结果。
使用腹部核心健康协作数据进行回顾性分析。纳入标准为 2013 年至 2021 年间接受择期复杂腹疝修复的 65 岁以上成年人。主要结局是根据困境社区指数五分位数定义的术后结局和复合疝复发。使用 Cox 比例风险模型进行复合复发，使用逻辑回归进行术后结局。
共纳入 4172 例患者。处于困境社区的患者更有可能是女性或少数族裔，并且体质量指数和美国麻醉医师协会分级更高。较低的困境社区指数五分位数与更大的疝（P=0.012）、开放修复（P=0.019）和 30 天并发症（P=0.05）相关。复发时间与困境社区指数五分位数之间没有关联（P=0.24）。经过调整分析，再入院、再次手术、复发和并发症之间没有显著差异。
来自更困境社区的患者表现出更差的临床状态，伴有更大的疝。这可能导致更高的开放修复和并发症发生率。然而，当调整这些变量后，困境社区指数五分位数之间的结局相似。这支持了在社会经济阶层中进行复杂疝修复的疗效。
