Disparities among Patients Experiencing Homelessness Undergoing Open Lower Extremity Bypass

The effect of homelessness on vascular surgery outcomes is not well documented. We investigated disparities among homeless adults undergoing open lower extremity bypass (LEB) procedures.

Data from the Nationwide Readmissions Database was retrospectively reviewed using International Classification of Diseases-10 procedure and diagnosis codes to identify patients with and without housing instability undergoing open LEB between 2018 and 2020. Primary end points were inpatient mortality, amputation rate, and 30-day readmission rate. Multivariable logistic regression along with chi-squared, Fisher's exact, and t-test were used for analysis.

A total of 58,082 patients underwent open LEB, of which 269 were homeless. Homelessness was associated with higher odds of 30-day readmission (odds ratios 1.8, 95% CI: 1.3-2.3) and amputation (odds ratio 2.4, 95% CI: 1.6-3.4). Patients experiencing homelessness were more likely to be younger, male, have greater disease severity, receive care in an unscheduled/emergent setting, and have a concomitant injury (P < 0.01). Patients experiencing homelessness had more procedures performed, demonstrated longer lengths of stay, had greater total monetary charges, and greater disease burden, with 49.4% experiencing major or extreme loss of function (P < 0.01). Both groups were primarily readmitted for surgical site infections. Independent of housing status, 30-day readmission was associated with female gender, chronic pulmonary disease, congestive heart failure, diabetes, myocardial infarction, renal disease, illness severity, hemorrhage, and amputation (P < 0.05).

Patients experiencing homelessness undergoing LEB were 2.4 times more likely to receive an amputation and 1.8 times more likely to be readmitted in 30 days. This data highlight the significant impact of housing and socioeconomic insecurity within the vascular surgery population.