The impact of Area Deprivation Index (ADI) in abdominal wall reconstruction (AWR)

The Area Deprivation Index(ADI) is a validated measure of socioeconomic status(SES) with a higher percentile indicating lower SES. This study evaluated the impact of ADI on elective abdominal wall reconstruction(AWR).

A prospective database was queried for open AWR patients from 1/2017-12/2023. ADI was determined for each patient. An optimal cut-point analysis utilizing Youden's J determined the ADI threshold for wound complications as a primary outcome. Patients were stratified by ADI ≥62 or <62.

Of 722 AWR patients, 362 had ADI≥62(average:79.0 ​± ​10.6) and 360 had ADI<62(average:39.3 ​± ​15.2). There was no difference in sex or age, but ADI≥62 had more Black patients(16.3 %vs.10.3 ​%;p ​= ​0.046), less private insurance(40.9 %vs.45.8 ​%;p ​= ​0.046), higher BMI(31.9 ​± ​6.9vs.30.0 ​± ​5.6 ​kg/m²;p ​< ​0.001), COPD(8.3 %vs.4.4 ​% p ​= ​0.035), diabetes(29.0 %vs.17.2 ​%;p ​< ​0.001), ASA-III(61.9 %vs.55.0 ​%;p ​= ​0.029), recurrent hernias(62.4 %vs.51.7 ​%;p ​= ​0.003), and dirty cases(14.4 %vs.7.8 ​%;p ​= ​0.004). Postoperative complications, readmissions, and reoperations were not statistically different. ADI was not predictive of wound complications on multivariable regression.

Despite increased disadvantage, comorbidity, and surgical complexity, patients of worse ADI had equal postoperative outcomes.