Postoperative Disparities Facing Patients Experiencing Homelessness: Opportunities for Advocacy From an...

Patients experiencing homelessness (PEH) continue to face significant disparities across the world. Many of these disparities not only have downstream medical consequences but also housing-based consequences, including propagation of chronic homelessness. The postoperative period is a time of great medical vulnerability for PEH. Without targeted intervention, PEH are at risk for progression of disparate outcomes and chronic vulnerability. As integral players in the patient's care team during this period, anesthesiologists are uniquely positioned to address these disparities and drive change for a critically marginalized population. In this review, we examine the current literature on disparities impacting PEH in the postoperative period, highlighting key areas such as complications, hospitalization length, readmission rates, acute emergency department (ED) utilization, cost to the health system, postoperative follow-up, and discharge processes. Despite the potential impact of these disparities, there is a paucity of literature specific to PEH. Additionally, given the variability of findings between institutions and across surgical specialties, further research characterizing disparities on a local level is required. Despite these gaps in knowledge, there is an urgent need for the creation and assessment of actionable interventions aimed at improving care for PEH. Here, we analyze themes from our review and propose interventions that anesthesiologists can lead, in collaboration with health system colleagues, to foster change.