The association of neighborhood social vulnerability with surgical textbook outcomes among patients undergoing hepatopancreatic surgery

Published on Aug 14, 2020in Surgery3.982
· DOI :10.1016/J.SURG.2020.06.032
Rosevine A Azap4
Estimated H-index: 4
(The Ohio State University Wexner Medical Center),
Anghela Z. Paredes20
Estimated H-index: 20
(The Ohio State University Wexner Medical Center)
+ 2 AuthorsTimothy M. Pawlik121
Estimated H-index: 121
(The Ohio State University Wexner Medical Center)
Sources
Abstract
Abstract Background Previous studies have largely examined social determinants of health relative to individual surgery quality metrics. We sought to characterize possible differences in “textbook outcome,” a composite measure of quality, relative to social vulnerability index. Methods The Medicare Standard Analytical Files from 2013 to 2017 were used to identify beneficiaries who underwent hepatopancreatic surgery. Individuals were stratified into 3 groups dependent on their social vulnerability (low, average, high). Textbook outcome was defined as absence of postoperative surgical complications, prolonged length of stay, 90-day readmission, and 90-day mortality. Results Among 32,142 patients who underwent hepatopancreatic surgery, 18,841 (58.6%) patients underwent a pancreatectomy, whereas 13,301 (41.4%) underwent a hepatectomy. The overall incidence of textbook outcome after hepatopancreatic surgery was 51.2% (n = 16,445). Patients with a low social vulnerability index who underwent pancreatic resection more often achieved a textbook outcome versus patients who had an average or high social vulnerability index (low social vulnerability index: 48.3% vs average social vulnerability index: 46.5% vs high social vulnerability index: 44.9%; P = .004). The odds of obtaining a textbook outcome after pancreatic surgery was inversely associated with degree of vulnerability (low social vulnerability index, referent: average social vulnerability index: odds ratio 0.94, 95% confidence interval 0.87–1.00 vs high social vulnerability index: odds ratio 0.89, 95% confidence interval 0.82–0.97). Similarly, social vulnerability index was independently associated with textbook outcome after hepatic resection. Likewise, there were increased risks and incidence of various postoperative surgical outcomes, including 90-day mortality and complications as the social vulnerability index increased. Conclusion Only one-half (51.2%) of Medicare beneficiaries achieved the composite quality textbook outcome metric. Social vulnerability was associated with lower attainment of textbook outcome and an increased risk of adverse postoperative surgical outcomes after hepatopancreatic surgery.
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Abstract Background Assessing composite measures of quality such as textbook outcome may be superior to focusing on individual parameters when evaluating hospital performance. The aim of the current study was to assess the impact of teaching hospital status on the occurrence of a textbook outcome after hepatopancreatic surgery. Methods The Medicare Inpatient Standard Analytic Files were used to identify patients undergoing hepatopancreatic surgery from 2013 to 2015 for a malignant indication. St...
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