Patient Income/Wealth Level & Postoperative Outcomes Within 90 Days of Surgery: A Systematic Review & Meta-analysis

Socioeconomic factors play a key role in patient outcomes. This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, considers the effect of patient income/wealth level on 90-d postoperative outcomes.

A comprehensive search strategy was used to identify original studies considering patient income or wealth level and 90-d postoperative outcomes in MEDLINE and Embase. Thirty-six studies covering 24,227,506 patients were included in this review from a total of 284 studies.

Qualitative analysis of the studies included found a clear association between lower patient income/wealth level and poorer 90-d postoperative outcomes. Medicaid health insurance status was associated with pooled adjusted odds ratio (OR) of 1.22 (95% confidence interval [CI] 1.11-1.35) for 90-d postoperative complications, 1.85 (95% CI 1.72-1.99) for 30-d postoperative mortality and 1.52 (95% CI 1.44-1.59) for 30-d postoperative readmission compared to private health insurance. Medicare health insurance status was associated with pooled adjusted OR of 1.39 (95% CI 1.27-1.52) for 30-d postoperative mortality and 1.24 (95% CI 1.19-1.28) for 30-d postoperative readmission compared to private health insurance. Uninsured health insurance status was associated with pooled adjusted OR of 1.16 (95% CI 1.03-1.32) for 90-d overall postoperative complications, 1.77 (95% CI 1.60-1.97) for 30-d postoperative mortality and 1.19 (95% CI 1.11-1.29) for 30-d postoperative readmission compared to private health insurance.

Socioeconomic factors, particularly patient income, play a key role in postoperative patient outcomes. Understanding and accounting for the effects of these on short-term and long-term surgical outcomes is key to improving patient outcomes through accurate risk stratification, enhanced perioperative preparation and improved postoperative care.