How Safe Is the Safety Net? Comparison of Ivor-Lewis Esophagectomy at a Safety-Net Hospital Using the NSQIP Database

Area of Science:

• Surgical Outcomes Research
• Health Equity in Surgery
• Healthcare Disparities

Background:

• Surgical outcomes at safety-net hospitals may be suboptimal for vulnerable populations.
• This study investigates Ivor-Lewis esophagectomy outcomes at a safety-net hospital.
• Comparison is made against the National Surgical Quality Improvement Program (NSQIP) database.

Purpose of the Study:

• To compare outcomes of Ivor-Lewis esophagectomy at a safety-net hospital versus a national cohort.
• To assess the quality of care provided to vulnerable patient populations in safety-net settings.
• To identify factors influencing surgical outcomes in safety-net hospitals.

Main Methods:

• Retrospective review of 78 Ivor-Lewis esophagectomy patients at a safety-net hospital (2013-2017).
• Comparison with 1,825 patients from the NSQIP database (2013-2015).
• Statistical analysis using Student's t-test and chi-square tests (p < 0.05 significance).

Main Results:

• Safety-net patients had higher rates of COPD and were more likely to be current smokers.
• No significant differences in mortality, readmission, or operative time were observed.
• Safety-net patients experienced fewer complications (16.7% vs 33.3%), fewer reoperations (6.4% vs 14.5%), and shorter hospital stays (10.3 vs 13.1 days).

Conclusions:

• Ivor-Lewis esophagectomy at a safety-net hospital resulted in fewer complications and reoperations.
• Shorter hospital length of stay was observed in the safety-net hospital cohort.
• Clinical pathways effectively optimize patient outcomes in safety-net hospitals for vulnerable populations.