Myers Hannah E W, Kunnath Nicholas, Ibrahim Andrew M
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Ann Surg. 2024 Aug 13. doi: 10.1097/SLA.0000000000006482.
To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels.
Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.e., urgent or emergent) surgery. It is possible that social capital-the resources available to individuals through their membership in a social network-may impact the likelihood of a planned procedure occurring.
Medicare beneficiaries who underwent one of three access-sensitive procedures (abdominal aortic aneurysm repair, colectomy for cancer, and ventral hernia repair) between 2016-2020 were stratified by their census tract level of social capital, the exposure variable. Outcomes included rate of unplanned surgery, readmission, 30-day mortality, and complications which were risk-adjusted with a logistic regression model that accounted for patient age, sex, race, comorbidities, and area deprivation.
A total of 975,048 beneficiaries were included (mean [SD] patient age, 76 [7.6] years; 443,190 were male [45.45%]). Compared to patients from census tracts in the highest overall social capital decile, those from census tracts with the least social capital were on average more likely to undergo unplanned surgery (40.67% versus 35.28%, OR=1.26 P<0.001). Additionally, beneficiaries in these communities were also more likely to experience postoperative complications (24.99% versus 22.90%, OR=1.12 P<0.001), but there was no significant difference in rates of readmission or mortality. When evaluating only elective procedures, the differences between the lowest and highest social capital decile groups reduced significantly for complications (12.77% versus 12.11%, OR=1.06 P=0.04), the differences in mortality rates collapsed, and differences in readmission rates remained insignificant.
These data suggest that Medicare beneficiaries who live in communities with lower social capital are more likely to undergo unplanned surgery for access-sensitive conditions. Efforts to improve social capital in these communities may be one strategy for reducing the rate of unplanned operations.
比较生活在社会资本水平不同普查区的受益人群中，对手术时机敏感的外科疾病的非计划手术发生率。
对手术时机敏感的外科疾病是指理想情况下应在择期进行筛查和治疗的疾病。然而，如果不进行治疗，这些疾病可能会导致非计划（即紧急或急症）手术。社会资本——个人通过其在社会网络中的成员身份可获得的资源——可能会影响计划手术发生的可能性。
2016年至2020年间接受三种对手术时机敏感的手术（腹主动脉瘤修复术、癌症结肠切除术和腹疝修补术）之一的医疗保险受益人，按其普查区的社会资本水平（暴露变量）进行分层。结果包括非计划手术发生率、再入院率、30天死亡率和并发症发生率，通过逻辑回归模型对这些结果进行风险调整，该模型考虑了患者的年龄、性别、种族、合并症和地区贫困程度。
共纳入975,048名受益人（患者平均年龄[标准差]为76[7.6]岁；443,190名男性[45.45%]）。与来自社会资本总体水平最高十分位数普查区的患者相比，来自社会资本最少普查区的患者平均更有可能接受非计划手术（40.67%对35.28%，OR=1.26，P<0.001）。此外，这些社区的受益人术后发生并发症的可能性也更高（24.99%对22.90%，OR=1.12，P<0.001），但再入院率或死亡率没有显著差异。仅评估择期手术时，社会资本最低和最高十分位数组之间并发症的差异显著减小（12.77%对12.11%，OR=1.06，P=0.04），死亡率差异消失，再入院率差异仍不显著。
这些数据表明，生活在社会资本较低社区的医疗保险受益人，更有可能因对手术时机敏感的疾病接受非计划手术。改善这些社区社会资本的努力可能是降低非计划手术发生率的一种策略。
