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Community Privilege and Unplanned Surgery for Access-sensitive Surgical Conditions
Muhammad Musaab Munir1, Selamawit Woldesenbet, Timothy M Pawlik
1Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH.
Annals of Surgery
|August 23, 2024
Summary
Areas with lower privilege are linked to higher rates of unplanned surgery and worse patient outcomes for access-sensitive conditions. This highlights privilege as a critical social determinant of health impacting surgical care quality.
Area of Science:
- Surgical outcomes research
- Health equity studies
- Social determinants of health (SDOH) analysis
Background:
- Social determinants of health (SDOH) significantly impact healthcare access.
- Privilege, defined as advantages or opportunities, positively influences SDOH.
- Understanding privilege's role is crucial for addressing health disparities.
Purpose of the Study:
- To investigate the association between socioeconomic privilege and surgical outcomes.
- To determine if privilege influences rates of unplanned surgery for access-sensitive conditions.
- To examine the impact of privilege on perioperative outcomes in surgical patients.
Main Methods:
- Utilized the California Department of Health Care Access and Information (HCAI) database (2017-2020).
- Included patients undergoing abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer.
- Merged patient data with the Index of Concentration of Extremes (ICE) using ZIP codes to measure privilege.
Main Results:
- Analyzed 185,316 surgical procedures; nearly half were unplanned (46.9%).
- Patients in lowest privilege areas (Q1) had higher rates of unplanned surgery (55.4% vs. 39.4%) compared to highest privilege areas (Q5).
- Least privileged areas showed increased inpatient mortality (OR 1.41), complications (OR 1.24), and extended hospital stays (OR 1.16).
Conclusions:
- Privilege is significantly associated with unplanned surgery rates and adverse clinical outcomes.
- This association underscores privilege as a key SDOH influencing surgical care access and quality.
- Findings emphasize the need to address socioeconomic factors to improve surgical equity.
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