December 9, 2021

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

By: Judy Mathias

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%).

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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.


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