Social and Structural Determinants of Health Impact Utilization of Emergency Surgical Services in a Regional Quality...

Emergency general surgery (EGS) is associated with increased morbidity. The unequal distribution of social and structural determinants of health (SSDH) may impact the need for EGS. We hypothesized that SSDH would be associated with an increased utilization of EGS and sought to evaluate the impact of SSDH on EGS utilization in a regional quality collaborative.

Patients undergoing general surgery procedures at 16 South Carolina Surgical Quality Collaborative hospitals between 08/2015 and 12/2021 were randomly selected for data abstraction and analysis. The primary outcome was utilization of EGS. Multivariable logistic regression assessed the odds of EGS controlling for demographics, comorbid conditions, and SSDH. SSDH included race (nonBlack and Black), distance to hospital (<50 miles and >50 miles), poverty (zip code >25% below federal poverty level), and insurance status (noncommercial and commercial).

29,514 cases were analyzed; 9258 (31%) were emergent. Univariate analysis revealed Black race, noncommercial insurance status, increased travel distance, and poverty were positively associated with EGS. Multivariable regression showed that Black race (odds ratio (OR): 1.15; 95% CI: 1.08-1.22), smoking (OR: 1.13; 95% CI: 1.06-1.21), and poverty (OR: 1.34; 95% CI: 1.26-1.42) were positively associated with EGS, while distance <50 miles (OR: 0.67; 95% CI: 0.61-0.74) and commercial insurance (OR: 0.79; 95% CI: 0.74-0.83) were negatively associated with EGS.

Within a diverse regional quality collaborative, SSDHs were associated with EGS. Black race was independently associated with EGS, suggesting that the uneven distribution of unmeasured SSDH by race including systemic, patient, and provider factors, may also impact the need for EGS.