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The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status.
Am J Surg. 2022 Feb; 223(2):353-359.AJ

Abstract

INTRODUCTION

Social vulnerability is an important driver of disparate surgical outcomes, however the extent to which certain types of vulnerability impact outcomes is poorly understood.

METHODS

Medicare beneficiaries 65 years or older who underwent one of four operations were identified. Multivariable mixed-effects logistic regression was used to measure the association of four social vulnerability subthemes from the social vulnerability index (SVI) were assessed relative to the likelihood to achieve a textbook outcome (TO).

RESULTS

Among 579,846 Medicare beneficiaries, median age was 74 years and most patients (536,455,92.5%) were White/non-Hispanic. On multivariable analysis, the overall impact of the composite SVI metric on the odds to achieve a postoperative TO was lower among White/non-Hispanic patients (Δ25%ile SVI:OR:0.98,95%CI:0.97-0.98) compared with ethnic/minority patients (Δ25%ile SVI:OR:0.93,95%CI:0.91-0.94). Increasing vulnerability in the subthemes of socioeconomic status (Δ25%ile SVI:ethnic/minority:OR:0.92, 95%CI:0.91-0.94) and household composition (Δ25%ile SVI:ethnic/minority:OR:0.92,95%CI:0.91-0.94) was associated with a greater likelihood not to achieve a TO among minority patients.

CONCLUSIONS

Worsening SES and household compositions & disability had a detrimental effect on odds of TO following surgery with the most pronounced effect on non-White minority patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Diaz A
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA; National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. Electronic address: Adriandi@med.umich.edu.
Hyer JM
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA.
Tsilimigras D
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA.
Pawlik TM
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, USA.

MeSH

AgedEthnic and Racial MinoritiesEthnicityHumansMedicareMinority GroupsSocial VulnerabilityUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34099239

Citation

Diaz, Adrian, et al. "The Impact of Social Vulnerability Subthemes On Postoperative Outcomes Differs By Racial/ethnic Minority Status." American Journal of Surgery, vol. 223, no. 2, 2022, pp. 353-359.
Diaz A, Hyer JM, Tsilimigras D, et al. The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status. Am J Surg. 2022;223(2):353-359.
Diaz, A., Hyer, J. M., Tsilimigras, D., & Pawlik, T. M. (2022). The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status. American Journal of Surgery, 223(2), 353-359. https://doi.org/10.1016/j.amjsurg.2021.05.014
Diaz A, et al. The Impact of Social Vulnerability Subthemes On Postoperative Outcomes Differs By Racial/ethnic Minority Status. Am J Surg. 2022;223(2):353-359. PubMed PMID: 34099239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status. AU - Diaz,Adrian, AU - Hyer,J Madison, AU - Tsilimigras,Diamantis, AU - Pawlik,Timothy M, Y1 - 2021/06/01/ PY - 2021/04/23/received PY - 2021/05/24/revised PY - 2021/05/25/accepted PY - 2021/6/9/pubmed PY - 2022/4/15/medline PY - 2021/6/8/entrez KW - Social determents of health KW - Textbook outcomes SP - 353 EP - 359 JF - American journal of surgery JO - Am J Surg VL - 223 IS - 2 N2 - INTRODUCTION: Social vulnerability is an important driver of disparate surgical outcomes, however the extent to which certain types of vulnerability impact outcomes is poorly understood. METHODS: Medicare beneficiaries 65 years or older who underwent one of four operations were identified. Multivariable mixed-effects logistic regression was used to measure the association of four social vulnerability subthemes from the social vulnerability index (SVI) were assessed relative to the likelihood to achieve a textbook outcome (TO). RESULTS: Among 579,846 Medicare beneficiaries, median age was 74 years and most patients (536,455,92.5%) were White/non-Hispanic. On multivariable analysis, the overall impact of the composite SVI metric on the odds to achieve a postoperative TO was lower among White/non-Hispanic patients (Δ25%ile SVI:OR:0.98,95%CI:0.97-0.98) compared with ethnic/minority patients (Δ25%ile SVI:OR:0.93,95%CI:0.91-0.94). Increasing vulnerability in the subthemes of socioeconomic status (Δ25%ile SVI:ethnic/minority:OR:0.92, 95%CI:0.91-0.94) and household composition (Δ25%ile SVI:ethnic/minority:OR:0.92,95%CI:0.91-0.94) was associated with a greater likelihood not to achieve a TO among minority patients. CONCLUSIONS: Worsening SES and household compositions & disability had a detrimental effect on odds of TO following surgery with the most pronounced effect on non-White minority patients. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/34099239/The_impact_of_social_vulnerability_subthemes_on_postoperative_outcomes_differs_by_racial/ethnic_minority_status_ DB - PRIME DP - Unbound Medicine ER -