County-level social vulnerability linked to worse postop outcomes, especially in minority patients

Editor's Note

This study from the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, finds that patients residing in vulnerable communities characterized by a high social vulnerability index (SVI) had worse postoperative outcomes, and the impact was most pronounced in Black/minority patients.

In this analysis of nearly 300,000 Medicare beneficiaries who underwent a colectomy (29.6%), coronary artery bypass graft (CABG) (36.6%), lung resection (10.1%), or lower extremity joint replacement (LEJR) (23.6%), the mean SVI score was 50.2, and minority patients were more likely to reside in highly vulnerable communities (low SVI, 5.8% vs high SVI 13.3%).

Risk-adjusted probability of a serious complication in patients from a high vs low SVI county was 10% to 20% higher after colectomy and CABG, but there was no association after lung resection or LEJR.

Risk-adjusted probability of 30-day mortality was higher in patients from high SVI counties after colectomy, CABG, and lung resection, but not after LEJR.

Black/minority patients undergoing colectomy, CABG, or lung resection who lived in highly socially vulnerable counties had a 28%-68% increased odds of a serious complication and a 58%-60% increased odds of 30-day mortality, compared with Black/minority patients who lived in low socially vulnerable counties, as well as a higher risk than White patients.

Efforts to ensure equitable surgical outcomes need to focus on patient-level and community-specific factors, the researchers say.