A Florida-Based Analysis of Bowel Surgery Outcomes: Does Income Predict Recovery?

Major small and large bowel surgeries are commonly performed in the United States (U.S.) for conditions that are associated with colorectal cancer, inflammatory bowel disease, and bowel obstruction. Factors such as hospital length of stay (LOS) and postoperative readmission rates are among the many outcome measures that could serve as markers for evaluating surgical effectiveness and the risk of complications. Additionally, socioeconomic status (SES) has been widely used as a predictor of postoperative outcomes across medical disciplines. Meanwhile, the relationship between hospital LOS, readmission rates, and SES has yet to be fully elucidated. As such, this study aims to evaluate whether county median household income, as a measure of SES in Florida, correlates with hospital LOS and 15-day potentially preventable readmission rates following major bowel procedures. Publicly available data on readmission rates and LOS were analyzed for major small- and large-bowel procedures, but data were not available for all counties in the state. This analysis included 48 of the 67 counties in the state. Data on postoperative outcomes were compared with the county median household income, which was stratified into quintiles. The second, third, and fourth quintile ranges included all of Florida counties. The vast majority (98.5%) of these counties were in the second and third quintiles. Regression analysis demonstrated no significant relationship between county median income and LOS. Similarly, comparisons of median income across the three readmission categories showed no statistically significant differences in the Kruskal-Wallis test. Despite demonstrating a limited association, these findings give valuable insight into the complexity of SES and postoperative outcomes, offering a clearer framework for understanding how socioeconomic conditions intersect with clinical factors. Additionally, median annual household income alone may not adequately capture the socioeconomic and structural factors influencing surgical recovery. Future research should prioritize obtaining complete readmission datasets, incorporate additional SES markers such as education, insurance status, and healthcare access, and conduct analyses at the patient- or neighborhood-level to provide a more refined view of the correlations. More granular evaluation may clarify if and which socioeconomic factors most strongly influence postoperative outcomes and guide targeted interventions to improve equity in surgical care.