Patient Social Vulnerability and Hospital Community Racial/Ethnic Integration: Do All Patients Undergoing Pancreatectomy Receive the Same Care Across Hospitals?

Hyer, J. Madison; Tsilimigras, Diamantis I.; Díaz, Adrián; Dalmacy, Djhenne; Paro, Alessandro; Pawlik, Timothy M.

doi:10.1097/sla.0000000000004989

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…[42][43][44] In the United States, unfavorable SDOH is linked to delayed access to health care, an increased rate of complications and readmissions, an increased incidence of urgent surgery or length of stay, higher unplanned birth rates, and even lower survival rates. [29][30][31][32][33][34][35][36][37][38][39][45][46][47] Although the link between SDOH and surgical outcomes has recently been described in pediatric surgery, it has yet to be fully explored in pediatric otolaryngology. 40 Furthermore, a patient's environment may be just as important, if not more, for optimal surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…To varying degrees, each of these specific factors has been identified as a social determinant of health 42–44 . In the United States, unfavorable SDOH is linked to delayed access to health care, an increased rate of complications and readmissions, an increased incidence of urgent surgery or length of stay, higher unplanned birth rates, and even lower survival rates 29–39,45–47 . Although the link between SDOH and surgical outcomes has recently been described in pediatric surgery, it has yet to be fully explored in pediatric otolaryngology 40 .…”

Section: Discussionmentioning

confidence: 99%

“…28 In the adult population, a high SVI is associated with higher complication rates, residual disability, postoperative mortality, and overall poorer surgical outcomes. [29][30][31][32][33][34][35][36][37][38][39] Furthermore, serious postoperative complications following pediatric general surgery have been demonstrated from a retrospective cohort study employing the National Surgical Quality Improvement Program database. 40 However, no study has thoroughly examined the impact of neighborhood-level factors, as measured by the SVI, on complications or readmissions in patients following T&A.…”

Section: Introductionmentioning

confidence: 99%

“…In the adult population, a high SVI is associated with higher complication rates, residual disability, postoperative mortality, and overall poorer surgical outcomes 29–39 . Furthermore, serious postoperative complications following pediatric general surgery have been demonstrated from a retrospective cohort study employing the National Surgical Quality Improvement Program database 40 .…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

Nieri,

Davies,

Luttrell

et al. 2023

The Laryngoscope

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ObjectiveTo investigate the impact of neighborhood‐level social vulnerability on pediatric tonsillectomy outcomes.MethodsThis single‐center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census‐tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two‐sided Pearson chi‐square tests were used, whereas for continuous variables, paired t‐tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post‐T&A complications and readmissions.ResultsThe study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128–22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270–28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275–31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293–79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089–29.396).ConclusionSocial vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community‐based interventions. Because of the increased risk, it may have implications for preoperative decision‐making, treatment plans, and clinic follow‐ups.Level of evidenceIII. Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

Nieri,

Davies,

Luttrell

et al. 2023

The Laryngoscope

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“…While patients with high SVI may be less likely to receive care at high volume centers, 16 , 17 , 22 which could contribute to worse outcomes, 16 , 17 , 22 , 22 – 24 the lack of access to centralized care does not completely explain the discrepancy in post-hepatectomy and post-pancreatectomy outcomes experienced by patients residing in areas of high versus low composite SVI. 22 , 25 In order to better understand the impact of SDH on the outcomes of complex HP surgery and identify areas that would most benefit from policy reform, perioperative interventions, and/or community program support, we sought to define the impact of SVI subtheme scores relative to the likelihood of achieving an “optimal” postoperative textbook surgical outcome. We hypothesized that certain SVI subthemes would improve risk stratification among patients undergoing HP surgery who reside in highly distressed areas with poor SDH.…”

Section: Introductionmentioning

confidence: 99%

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

Labiner

Hyer

Cloyd

et al. 2022

Journal of Gastrointestinal Surgery

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Background There has been increased interest in understanding how social determinants of health (SDH) may affect care both in the medical and surgical setting. We sought to define the impact of various aspects of social vulnerability on the ability of patients to achieve a “textbook outcome” (TO) following hepatopancreatic surgery. Methods Medicare beneficiaries who underwent hepatopancreatic resection between 2013 and 2017 were identified using the Medicare database. Social vulnerability was defined using the Centers for Disease Control Social Vulnerability Index (SVI), which is comprised of four subthemes: socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). TO was defined as the composite endpoint: absence of 90-day mortality or readmission, absence of an extended length of stay (LOS), and no complications during the index admission. Cluster analysis was used to identify vulnerability cohorts, and multivariable logistic regression was utilized to assess the impact of these SVI subthemes on the likelihood to achieve a textbook outcome. Results Among 37,707 Medicare beneficiaries, 64.9% ( n = 24,462) of patients underwent pancreatic resection while 35.1% ( n = 13,245) underwent hepatic resection. Median patient age was 72 years (IQR: 68–77), just over one-half were male (51.9%; n = 19,558), and the median CCI was 3 (IQR: 2–8). Cluster analysis revealed five distinct SVI profiles with wide variability in the distribution of SVI subthemes, ranging from 15 (profile 1 IQR: 7–26) to 83 (profile 5 IQR: 66–93). The five profiles were grouped into 3 categories based on median composite SVI: “low vulnerability” (profile 1), “average vulnerability” (profiles 2 and 3), or “high vulnerability” (profiles 4 and 5). The rate of TO ranged from 44.6% in profile 5 ( n = 4022) to 49.2% in profile 1 ( n = 4836). Multivariable analyses comparing patients categorized into the two average SVI profiles revealed that despite having similar composite SVI scores, the risk of adverse postoperative outcomes was not similar. Specifically, patients from profile 5 had lower odds of achieving a TO (OR 0.89, 95%CI: 0.83–0.95) and higher odds of 90-day mortality (OR 1.29, 95%CI: 1.15–1.44) versus patients in profile 4. Conclusion Distinct profiles of SVI subtheme characteristics were independently associated with postoperative outcomes among Medicare beneficiaries undergoing HP surgery, even among patients with similar overall composite SVI scores. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-022-05245-9.

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Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer

Rashid,

Munir,

Woldesenbet

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesPancreatic cancer (PDAC) requires a multimodality approach. We sought to define the association between social determinants of health (SDOH) and delayed or nonreceipt of adjuvant chemotherapy (aCT) among patients undergoing PDAC resection.MethodsData on patients who underwent PDAC resection between 2014 and 2020 were identified from Medicare Standard Analytic Files and merged with the county‐level social vulnerability index (SVI). Mediation analysis defined the association between SVI subthemes and aCT receipt.ResultsAmong 24 078 patients, 47.7% received timely aCT, 17.7% received delayed aCT, and 34.6% did not receive any aCT. High SVI was associated with delay (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.10–1.34) and nonreceipt of aCT (OR 1.30, 95% CI 1.20–1.41) (both p < 0.05). 73.1% of the variation in timely aCT receipt was directly attributable to SVI, whereas 26.9% of the effect was due to indirect mediators including hospital volume (6.4%), length‐of‐stay (7.9%) and postoperative complications (12.6%). Socioeconomic status (delayed aCT: OR 1.25, 95% CI 1.13–1.38; nonreceipt aCT: OR 1.25, 95% CI 1.15–1.36) and household composition and disability (delayed aCT: OR 1.30, 95% CI 1.17–1.43; nonreceipt aCT: OR 1.19, 95% CI 1.09–1.29) were associated with receipt of aCT (both p < 0.001).ConclusionsMost of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.

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Patient Social Vulnerability and Hospital Community Racial/Ethnic Integration: Do All Patients Undergoing Pancreatectomy Receive the Same Care Across Hospitals?

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 40 publications

Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer

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