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Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery.
Surgery. 2022 04; 171(4):1043-1050.S

Abstract

BACKGROUND

Regionalization of hepatopancreatic surgery to high-volume hospitals has been associated with fragmentation of postoperative care and, in turn, inferior outcomes after surgery. The objective of this study was to examine the association of social vulnerability with the likelihood of experiencing fragmentation of postoperative care (FPC) after hepatopancreatic surgery.

METHODS

Patients who underwent hepatopancreatic surgery and had at least 1 readmission within 90 days were identified using Medicare 100% Standard Analytical Files between 2013 and 2017. Fragmentation of postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index and its components with fragmentation of postoperative care was examined.

RESULTS

Among 11,142 patients, 8,053 (72.3%) underwent pancreatectomy, and 3,089 (27.7%) underwent hepatectomy. The overall incidence of fragmentation of postoperative care was 32.9% (n = 3,667). Patients who experienced fragmentation of postoperative care were older (73 years [interquartile range: 69-77]FPC vs 72 years [interquartile range: 68-77]non-FPC) and had a higher Charlson comorbidity score (4 [interquartile range: 2-8]FPC vs 3 [interquartile range: 2-8]non-FPC) (both P < .001). Median overall social vulnerability index was higher among patients who experienced fragmentation of postoperative care (52.5 [interquartile range: 29.3-70.4]FPC vs 51.3 [interquartile range: 27.9-69.4]non-FPC, P = .02). On multivariable analysis, the odds of experiencing fragmentation of postoperative care was higher with increasing overall social vulnerability index (odds ratio: 1.14; 95% confidence interval 1.01-1.30). Additionally, the odds of experiencing fragmentation of postoperative care were higher among patients with high vulnerability owing to their socioeconomic status (odds ratio: 1.28; 95% confidence interval 1.12-1.45) or their household composition and disability (odds ratio: 1.35; 95% confidence interval 1.19-1.54), whereas high vulnerability owing to minority status and language was inversely associated with fragmentation of postoperative care (odds ratio: 0.73; 95% confidence interval 0.64-0.84).

CONCLUSION

Social vulnerability was strongly associated with the odds of experiencing fragmented postoperative care after hepatopancreatic surgery.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Dalmacy DM
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: https://twitter.com/timpawlik.
Tsilimigras DI
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Hyer JM
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Paro A
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Diaz A
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Pawlik TM
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: tim.pawlik@osumc.edu.

MeSH

AgedHepatectomyHumansMedicarePancreatectomyPatient ReadmissionPostoperative CarePostoperative ComplicationsSocial VulnerabilityUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34538339

Citation

Dalmacy, Djhenne M., et al. "Social Vulnerability and Fragmentation of Postoperative Surgical Care Among Patients Undergoing Hepatopancreatic Surgery." Surgery, vol. 171, no. 4, 2022, pp. 1043-1050.
Dalmacy DM, Tsilimigras DI, Hyer JM, et al. Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery. Surgery. 2022;171(4):1043-1050.
Dalmacy, D. M., Tsilimigras, D. I., Hyer, J. M., Paro, A., Diaz, A., & Pawlik, T. M. (2022). Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery. Surgery, 171(4), 1043-1050. https://doi.org/10.1016/j.surg.2021.08.030
Dalmacy DM, et al. Social Vulnerability and Fragmentation of Postoperative Surgical Care Among Patients Undergoing Hepatopancreatic Surgery. Surgery. 2022;171(4):1043-1050. PubMed PMID: 34538339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery. AU - Dalmacy,Djhenne M, AU - Tsilimigras,Diamantis I, AU - Hyer,J Madison, AU - Paro,Alessandro, AU - Diaz,Adrian, AU - Pawlik,Timothy M, Y1 - 2021/09/15/ PY - 2021/04/13/received PY - 2021/08/18/revised PY - 2021/08/19/accepted PY - 2021/9/21/pubmed PY - 2022/4/20/medline PY - 2021/9/20/entrez SP - 1043 EP - 1050 JF - Surgery JO - Surgery VL - 171 IS - 4 N2 - BACKGROUND: Regionalization of hepatopancreatic surgery to high-volume hospitals has been associated with fragmentation of postoperative care and, in turn, inferior outcomes after surgery. The objective of this study was to examine the association of social vulnerability with the likelihood of experiencing fragmentation of postoperative care (FPC) after hepatopancreatic surgery. METHODS: Patients who underwent hepatopancreatic surgery and had at least 1 readmission within 90 days were identified using Medicare 100% Standard Analytical Files between 2013 and 2017. Fragmentation of postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index and its components with fragmentation of postoperative care was examined. RESULTS: Among 11,142 patients, 8,053 (72.3%) underwent pancreatectomy, and 3,089 (27.7%) underwent hepatectomy. The overall incidence of fragmentation of postoperative care was 32.9% (n = 3,667). Patients who experienced fragmentation of postoperative care were older (73 years [interquartile range: 69-77]FPC vs 72 years [interquartile range: 68-77]non-FPC) and had a higher Charlson comorbidity score (4 [interquartile range: 2-8]FPC vs 3 [interquartile range: 2-8]non-FPC) (both P < .001). Median overall social vulnerability index was higher among patients who experienced fragmentation of postoperative care (52.5 [interquartile range: 29.3-70.4]FPC vs 51.3 [interquartile range: 27.9-69.4]non-FPC, P = .02). On multivariable analysis, the odds of experiencing fragmentation of postoperative care was higher with increasing overall social vulnerability index (odds ratio: 1.14; 95% confidence interval 1.01-1.30). Additionally, the odds of experiencing fragmentation of postoperative care were higher among patients with high vulnerability owing to their socioeconomic status (odds ratio: 1.28; 95% confidence interval 1.12-1.45) or their household composition and disability (odds ratio: 1.35; 95% confidence interval 1.19-1.54), whereas high vulnerability owing to minority status and language was inversely associated with fragmentation of postoperative care (odds ratio: 0.73; 95% confidence interval 0.64-0.84). CONCLUSION: Social vulnerability was strongly associated with the odds of experiencing fragmented postoperative care after hepatopancreatic surgery. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/34538339/Social_vulnerability_and_fragmentation_of_postoperative_surgical_care_among_patients_undergoing_hepatopancreatic_surgery_ DB - PRIME DP - Unbound Medicine ER -