Social vulnerability is associated with increased postoperative morbidity following esophagectomy

Stuart, Christina M.; Dyas, Adam R.; Byers, Sara; Velopulos, Catherine G.; Randhawa, Simran; David, Elizabeth A.; Pritap, Akshay; Stewart, Camille L.; Mitchell, John D.; McCarter, Martin D.; Meguid, Robert A.

doi:10.1016/j.jtcvs.2023.04.027

Cited by 7 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further studies also showed the association between SVI and the overall group of post-operative complications that includes pulmonary failure, pneumonia, myocardial infarction, deep venous thrombosis, pulmonary embolism, renal failure, surgical site infection, gastrointestinal bleeding, and postoperative hemorrhage [ 15 , 16 ]. Stuart et al [ 18 ] studied individual postoperative complications and found that esophagectomy patients with high SVI had greater rates of pneumonia, jejunal feeding-tube complications, and unplanned readmission. Carmichael et al [ 17 ] also studied specific post-operative complications and found that colorectal surgery patients in the highest SVI quartile have an increased risk of mechanical ventilation for more than 48 h postoperatively, surgical site infection, and sepsis/septic shock.…”

Section: Discussionmentioning

confidence: 99%

Social vulnerability and surgery outcomes: a cross-sectional analysis

Abdelhack,

Tripathi,

Chen

et al. 2024

BMC Public Health

View full text Add to dashboard Cite

Background Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. Methods In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. Results Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. Conclusions Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Social vulnerability and surgery outcomes: a cross-sectional analysis

Abdelhack,

Tripathi,

Chen

et al. 2024

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…In this context, social vulnerability can be defined as the degree to which a persons’ overall social circumstances leave them susceptible to further insults, including health adverse events ( 21 ). At present, SVI has been identified as an important factor associated with increased risk of postoperative adverse outcomes and 30-day mortality following major surgery, including specific demonstration in colectomy ( 15 ) and esophagectomy ( 16 ) patients. Two prior studies by Diaz et al ( 22 ) and Hyer et al ( 23 ) both performed subgroup analyses on patients who underwent lung resection among a larger cohort of other major surgeries and demonstrated that patients with high SVI patients had increased rates of post-operative complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies in the medical literature have linked high SVI (increased social vulnerability) to poor health outcomes at the patient level. Specific to surgery, high SVI has been associated with increased rates of postoperative adverse outcomes following major surgery, including colectomy ( 15 ) and esophagectomy ( 16 ), regardless of approach (open versus minimally invasive). However, a comprehensive analysis of 30-day postoperative outcomes following RATS lung resection has not been performed.…”

Section: Introductionmentioning

confidence: 99%

Social vulnerability is associated with post-operative morbidity following robotic-assisted lung resection

Stuart,

Dyas,

Byers

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

Background The social vulnerability index (SVI) is a neighborhood-based metric used to determine an individual’s susceptibility to socioeconomic hardship, with high SVI indicating high susceptibility. SVI has previously been associated with surgical outcomes. We aimed to determine if SVI influences morbidity following robotic-assisted lung resection. Methods This was a retrospective cohort study at one academic medical center (1/1/2021–11/30/2022). Patients undergoing robotic-assisted lung resection were grouped into low (<75 th percentile) and high (≥75 th percentile) SVI cohorts. The primary outcome was 30-day overall morbidity; secondary outcomes were individual 30-day post-operative outcomes. Univariate analysis was performed using Chi-squared or Mann-Whitney- U tests, and multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) of postoperative complications. Results We included 320 patients, of which 40 patients (12.5%) in the high-SVI group and 280 (87.5%) in the low-SVI group. High SVI patients were more likely to be non-Caucasian and of Hispanic ethnicity, but there were no other differences in perioperative characteristics (all P>0.05). High SVI patients were more likely to experience a post-operative complication (42.5% vs. 24.6%, P=0.017), surgical site infection (SSI) (12.5% vs. 4.3%, P=0.047), hemothorax (5.0% vs. 0.0%, P=0.015), intensive care need (15.0% vs. 4.6%, P=0.021), sepsis (10.0% vs. 1.1%, P=0.006) and unplanned reoperation (5.0% vs. 0.4%, P=0.042). After risk-adjustment, the association of increased overall morbidity with high SVI persisted (OR =2.53; 95% confidence interval: 1.19–5.35). Conclusions High SVI was associated with increased risk-adjusted odds of morbidity after robotic-assisted lung resection. Highly vulnerable patients should be allocated perioperative resources to help mitigate the increased risk of these complications.

show abstract