Socioeconomic disadvantage and the risk for adverse post-operative outcomes after gynecologic cancer surgery

This study aimed to determine whether individuals living in socioeconomically disadvantaged areas were at higher risk for adverse post-operative outcomes including complications, mortality, and hospital re-admission after gynecologic cancer surgery.

Using the California Patient Discharge Data, we identified individuals aged 18 years and older undergoing gynecologic cancer surgery between 2008 and 2020. We included patients if they had a hospitalization where a gynecologic cancer was listed as the primary diagnosis code (International Classification of Diseases, Ninth and Tenth Revision) and an International Classification of Diseases, Ninth and Tenth Revision code(s) that corresponded to surgical treatment specific to that cancer. Individuals were excluded if record linkage number identifiers were missing, date of surgery was missing, or residential zip code was not listed. The social deprivation index was used as an aggregate measure of community socioeconomic characteristics. Higher social deprivation index values correspond to higher levels of socioeconomic disadvantage. Our primary outcome was the incidence of post-operative complications within 30 days of surgery; secondary outcomes included in-hospital post-operative mortality, severe post-operative complications, and post-operative re-admissions. The χ² tests and Kruskal-Wallis tests were used to test for differences in the distribution of patient and hospital characteristics by the incidence of any post-surgical complication. Multi-variable marginal logistic regression models were used to assess the associations between patient and hospital characteristics and outcomes of interest.

There were 57,823 patients who were included in our study, and 6616 patients (11.4%) who experienced at least 1 post-operative complication. The median social deprivation index score of patients experiencing a complication was higher than those who did not (62 [interquartile range; 36-84] vs. 60 [interquartile range; 34-83], p < .001). An individual living in social deprivation index quintile 5 (ie, area with highest socioeconomic disadvantage) had higher odds of experiencing a post-operative complication (adjusted odds ratio vs. quintile 1, 1.15 [95% confidence interval [CI] 1.04 to 1.27]). The adjusted predicted probability that they would experience a post-operative complication was 1.3 percentage points higher (0.4-2.3, p = .006) than an individual in quintile 1. Individuals living in quintile 5 faced higher odds of in-hospital post-operative mortality (adjusted odds ratio vs quintile 1, 1.64 [95% CI 1.11 to 2.43]).

Individuals living in socioeconomically disadvantaged areas face a higher probability for post-operative complications and in-hospital post-operative mortality after gynecologic cancer surgery. Although the magnitude of the effect is small, the impact of an individual's socioeconomic background on post-operative outcomes can be observed independently of frequently associated co-variates such as race, ethnicity, and health insurance status.