Housing Instability and Outcomes Among Patients With Access-Sensitive Surgical Conditions

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Economics

Background:

• Housing instability is a known social determinant of health, yet its impact on surgical patients is understudied.
• Access-sensitive surgical conditions require timely intervention, making housing stability crucial for optimal care.

Purpose of the Study:

• To evaluate the association between housing instability and unplanned surgical procedures.
• To assess the impact of housing instability on health and financial outcomes in patients undergoing access-sensitive surgeries.

Main Methods:

• Utilized the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database.
• Identified patients undergoing specific access-sensitive surgical procedures using International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes for housing status (Z59.0, Z59.1).
• Employed risk-adjusted multivariable logistic regression to compare outcomes between housing-stable and housing-unstable patient groups.

Main Results:

• Housing-unstable individuals had over four times the odds of undergoing unplanned surgery (OR 4.41, P < 0.001).
• Patients with housing instability experienced longer hospital stays and higher costs after planned surgery.
• No significant differences in morbidity or mortality were observed between groups following unplanned surgeries; housing-unstable patients had lower complication and mortality rates after planned surgeries.

Conclusions:

• Housing instability is linked to a higher likelihood of unplanned surgeries, increased hospital stays, and elevated costs.
• Despite challenges, patients with housing instability demonstrated comparable or improved surgical outcomes.
• Expanding affordable housing initiatives may enhance access to timely and effective surgical care.