Tags

Type your tag names separated by a space and hit enter

Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries.
J Am Coll Surg. 2023 01 01; 236(1):208-217.JA

Abstract

BACKGROUND

Although the Social Vulnerability Index (SVI) was created to identify vulnerable populations after unexpected natural disasters, its ability to identify similar groups of patients undergoing unexpected emergency surgical procedures is unknown. We sought to examine the association between SVI and outcomes after emergency general surgery.

STUDY DESIGN

This study is a cross-sectional review of 887,193 Medicare beneficiaries who underwent 1 of 4 common emergency general surgery procedures (appendectomy, cholecystectomy, colectomy, and ventral hernia repair) performed in the urgent or emergent setting between 2014 and 2018. These data were merged with the SVI at the census-track level of residence. Risk-adjusted outcomes (30-day mortality, serious complications, readmission) were evaluated using a logistic regression model accounting for age, sex, comorbidity, year, procedure type, and hospital characteristics between high and low social vulnerability quintiles and within the 4 SVI subthemes (socioeconomic status; household composition and disability; minority status and language; and housing type and transportation).

RESULTS

Compared with beneficiaries with low social vulnerability, Medicare beneficiaries living in areas of high social vulnerability experienced higher rates of 30-day mortality (8.56% vs 8.08%; adjusted odds ratio 1.07; p < 0.001), serious complications (20.71% vs 18.40%; adjusted odds ratio 1.17; p < 0.001), and readmissions (16.09% vs 15.03%; adjusted odds ratio 1.08; p < 0.001). This pattern of differential outcomes was present in subgroup analysis of all 4 SVI subthemes but was greatest in the socioeconomic status and household composition and disability subthemes.

CONCLUSIONS

National efforts to support patients with high social vulnerability from natural disasters may be well aligned with efforts to identify communities that are particularly vulnerable to worse postoperative outcomes after emergency general surgery. Policies targeting structural barriers related to household composition and socioeconomic status may help alleviate these disparities.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Zhang Y
From the National Clinician Scholars Program at the Clinical Research Training Program, Duke University, Durham, NC (Zhang). Department of Surgery, Yale University, New Haven, CT (Zhang).
Kunnath N
Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI. Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.
Dimick JB
Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI. Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.
Scott JW
Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI.
Ibrahim AM
Department of Surgery (Kunnath, Dimick, Scott, Ibrahim), University of Michigan, Ann Arbor, MI. Center for Healthcare Outcomes and Policy (Kunnath, Dimick, Ibrahim), University of Michigan, Ann Arbor, MI.

MeSH

HumansAgedUnited StatesMedicareCross-Sectional StudiesSocial VulnerabilityHospitalsCholecystectomy

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36519918

Citation

Zhang, Yuqi, et al. "Social Vulnerability and Emergency General Surgery Among Medicare Beneficiaries." Journal of the American College of Surgeons, vol. 236, no. 1, 2023, pp. 208-217.
Zhang Y, Kunnath N, Dimick JB, et al. Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries. J Am Coll Surg. 2023;236(1):208-217.
Zhang, Y., Kunnath, N., Dimick, J. B., Scott, J. W., & Ibrahim, A. M. (2023). Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries. Journal of the American College of Surgeons, 236(1), 208-217. https://doi.org/10.1097/XCS.0000000000000429
Zhang Y, et al. Social Vulnerability and Emergency General Surgery Among Medicare Beneficiaries. J Am Coll Surg. 2023 01 1;236(1):208-217. PubMed PMID: 36519918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries. AU - Zhang,Yuqi, AU - Kunnath,Nicholas, AU - Dimick,Justin B, AU - Scott,John W, AU - Ibrahim,Andrew M, Y1 - 2022/12/15/ PY - 2024/01/01/pmc-release PY - 2022/12/16/pubmed PY - 2022/12/20/medline PY - 2022/12/15/entrez SP - 208 EP - 217 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 236 IS - 1 N2 - BACKGROUND: Although the Social Vulnerability Index (SVI) was created to identify vulnerable populations after unexpected natural disasters, its ability to identify similar groups of patients undergoing unexpected emergency surgical procedures is unknown. We sought to examine the association between SVI and outcomes after emergency general surgery. STUDY DESIGN: This study is a cross-sectional review of 887,193 Medicare beneficiaries who underwent 1 of 4 common emergency general surgery procedures (appendectomy, cholecystectomy, colectomy, and ventral hernia repair) performed in the urgent or emergent setting between 2014 and 2018. These data were merged with the SVI at the census-track level of residence. Risk-adjusted outcomes (30-day mortality, serious complications, readmission) were evaluated using a logistic regression model accounting for age, sex, comorbidity, year, procedure type, and hospital characteristics between high and low social vulnerability quintiles and within the 4 SVI subthemes (socioeconomic status; household composition and disability; minority status and language; and housing type and transportation). RESULTS: Compared with beneficiaries with low social vulnerability, Medicare beneficiaries living in areas of high social vulnerability experienced higher rates of 30-day mortality (8.56% vs 8.08%; adjusted odds ratio 1.07; p < 0.001), serious complications (20.71% vs 18.40%; adjusted odds ratio 1.17; p < 0.001), and readmissions (16.09% vs 15.03%; adjusted odds ratio 1.08; p < 0.001). This pattern of differential outcomes was present in subgroup analysis of all 4 SVI subthemes but was greatest in the socioeconomic status and household composition and disability subthemes. CONCLUSIONS: National efforts to support patients with high social vulnerability from natural disasters may be well aligned with efforts to identify communities that are particularly vulnerable to worse postoperative outcomes after emergency general surgery. Policies targeting structural barriers related to household composition and socioeconomic status may help alleviate these disparities. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/36519918/Social_Vulnerability_and_Emergency_General_Surgery_among_Medicare_Beneficiaries_ DB - PRIME DP - Unbound Medicine ER -