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Impact of hospital quality on surgical outcomes in patients with high social vulnerability: Association of textbook outcomes and social vulnerability by hospital quality.
Surgery. 2022 06; 171(6):1612-1618.S

Abstract

BACKGROUND

We sought to define the impact of high- versus low-quality hospitals on the risk of adverse outcomes among patients undergoing hepatopancreatic surgery relative to social vulnerability. Social vulnerability is an important factor associated with risk of adverse postoperative outcomes.

METHODS

Patients from 2013 to 2017 were identified from the Medicare Inpatient Standard Analytic File. Hospital quality was determined by calculating risk-adjusted probability to achieve a textbook outcome. The Social Vulnerability Index was used to categorize patients. Risk-adjusted probability of mortality, morbidity, and textbook outcome was examined across varying social vulnerability indices stratified by low-, average-, and high-quality hospitals.

RESULTS

Among 27,000 patients who underwent a pancreatectomy (67%) or hepatectomy (33%%), median patient age was 72 years, 48% were female, and 89% were White; mean Social Vulnerability Index was 49. Risk-adjusted 90-day mortality (odds ratio: 1.32, 95% CI: 1.20-1.59, P = .004) and postoperative complications (odds ratio: 1.12, 95% confidence interval: 1.00-1.24, P = .044) were both higher among beneficiaries from the highest social vulnerability counties versus the lowest counties. At low-quality hospitals, patients from the highest vulnerability counties had 70% higher odds of mortality (odds ratio: 1.70, 95% confidence interval: 1.16-2.48, P = .007), 31% higher odds of overall morbidity odds ratio: 1.31, 95% confidence interval: 1.05-2.63, P = .013), and 19% lower odds of achieving a textbook outcome (odds ratio: 0.81, 95% confidence interval: 0.66-0.99, P = .035)-all of which were markedly worse compared with outcomes achieved at high-quality hospitals.

CONCLUSION

Among patients with increased social vulnerability, outcomes were considerably better at high-quality hospitals. Referral of socially vulnerable patients to high-quality hospitals represents an important opportunity to ensure optimal outcomes after complex surgery.

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, Ann Arbor, MI; National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI. Electronic address: adriandi@med.umich.edu.
Beane JD
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Ann Arbor, MI.
Hyer JM
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Ann Arbor, MI.
Tsilimigras D
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Ann Arbor, MI.
Pawlik TM
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Ann Arbor, MI. Electronic address: https://www.twitter.com/timpawlik.

MeSH

AgedFemaleHospitalsHumansMaleMedicarePancreatectomyPostoperative ComplicationsSocial VulnerabilityTreatment OutcomeUnited States

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

34774291

Citation

Diaz, Adrian, et al. "Impact of Hospital Quality On Surgical Outcomes in Patients With High Social Vulnerability: Association of Textbook Outcomes and Social Vulnerability By Hospital Quality." Surgery, vol. 171, no. 6, 2022, pp. 1612-1618.
Diaz A, Beane JD, Hyer JM, et al. Impact of hospital quality on surgical outcomes in patients with high social vulnerability: Association of textbook outcomes and social vulnerability by hospital quality. Surgery. 2022;171(6):1612-1618.
Diaz, A., Beane, J. D., Hyer, J. M., Tsilimigras, D., & Pawlik, T. M. (2022). Impact of hospital quality on surgical outcomes in patients with high social vulnerability: Association of textbook outcomes and social vulnerability by hospital quality. Surgery, 171(6), 1612-1618. https://doi.org/10.1016/j.surg.2021.10.021
Diaz A, et al. Impact of Hospital Quality On Surgical Outcomes in Patients With High Social Vulnerability: Association of Textbook Outcomes and Social Vulnerability By Hospital Quality. Surgery. 2022;171(6):1612-1618. PubMed PMID: 34774291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of hospital quality on surgical outcomes in patients with high social vulnerability: Association of textbook outcomes and social vulnerability by hospital quality. AU - Diaz,Adrian, AU - Beane,Joal D, AU - Hyer,J Madison, AU - Tsilimigras,Diamantis, AU - Pawlik,Timothy M, Y1 - 2021/11/11/ PY - 2021/08/29/received PY - 2021/10/01/revised PY - 2021/10/08/accepted PY - 2021/11/15/pubmed PY - 2022/6/1/medline PY - 2021/11/14/entrez SP - 1612 EP - 1618 JF - Surgery JO - Surgery VL - 171 IS - 6 N2 - BACKGROUND: We sought to define the impact of high- versus low-quality hospitals on the risk of adverse outcomes among patients undergoing hepatopancreatic surgery relative to social vulnerability. Social vulnerability is an important factor associated with risk of adverse postoperative outcomes. METHODS: Patients from 2013 to 2017 were identified from the Medicare Inpatient Standard Analytic File. Hospital quality was determined by calculating risk-adjusted probability to achieve a textbook outcome. The Social Vulnerability Index was used to categorize patients. Risk-adjusted probability of mortality, morbidity, and textbook outcome was examined across varying social vulnerability indices stratified by low-, average-, and high-quality hospitals. RESULTS: Among 27,000 patients who underwent a pancreatectomy (67%) or hepatectomy (33%%), median patient age was 72 years, 48% were female, and 89% were White; mean Social Vulnerability Index was 49. Risk-adjusted 90-day mortality (odds ratio: 1.32, 95% CI: 1.20-1.59, P = .004) and postoperative complications (odds ratio: 1.12, 95% confidence interval: 1.00-1.24, P = .044) were both higher among beneficiaries from the highest social vulnerability counties versus the lowest counties. At low-quality hospitals, patients from the highest vulnerability counties had 70% higher odds of mortality (odds ratio: 1.70, 95% confidence interval: 1.16-2.48, P = .007), 31% higher odds of overall morbidity odds ratio: 1.31, 95% confidence interval: 1.05-2.63, P = .013), and 19% lower odds of achieving a textbook outcome (odds ratio: 0.81, 95% confidence interval: 0.66-0.99, P = .035)-all of which were markedly worse compared with outcomes achieved at high-quality hospitals. CONCLUSION: Among patients with increased social vulnerability, outcomes were considerably better at high-quality hospitals. Referral of socially vulnerable patients to high-quality hospitals represents an important opportunity to ensure optimal outcomes after complex surgery. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/34774291/Impact_of_hospital_quality_on_surgical_outcomes_in_patients_with_high_social_vulnerability:_Association_of_textbook_outcomes_and_social_vulnerability_by_hospital_quality_ DB - PRIME DP - Unbound Medicine ER -