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Socioeconomic position and preoperative characteristics in Perioperative Quality Improvement Programme participants:
James Durrand1, Bo Hou2, Adam Hunt3
1Department of Anaesthesia and Perioperative Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK; Centre for Perioperative Medicine, Research Department of Targeted Intervention, Faculty of Medical Sciences, University College London, London, UK; Centre for Research and Improvement, Royal College of Anaesthetists, London, UK.
Background:
Patients from more deprived backgrounds experience poorer postoperative outcomes. We analysed preoperative characteristics in UK Perioperative Quality Improvement Programme participants according to socioeconomic position to explore opportunities for targeted interventions.
Methods:
Participants were adults aged ≥18 yr undergoing major elective surgery at UK Perioperative Quality Improvement Programme sites. Socioeconomic position was determined using postcode data and the Index of Multiple Deprivation (IMD) standardised aggregate scale of area-level deprivation. Associations between IMD position and patient characteristics, health behaviours, and comorbidities were analysed using descriptive statistics with appropriate parametric and nonparametric testing.
Results:
Of 55 938 participants included, quintile 1 (most deprived) represented the smallest subgroup (14.2%), with recruitment varying by region and site. Median age was 66 yr with IMD 1 participants 5 yr younger (62 yr) than IMD 5 (67 yr). Deprivation gradients (IMD 5 to 1) were seen for home ownership, occupation, and educational attainment. Prevalences of smoking, inactivity, and obesity increased from IMD 5 to 1. Higher prevalences of major long-term conditions including diabetes mellitus, heart failure, stroke, and ASA physical status 3-4 were observed in more deprived quintiles. Prevalence rates of dementia and renal impairment were similar across quintiles despite the age gradient. Notably, the proportions of patients living with frailty and disability increased with deprivation.
Conclusions:
Patients presenting for major surgery from more deprived backgrounds do so in poorer overall health. They can encounter barriers to both research participation and available preoperative support. Addressing this unmet need to prevent widening perioperative health inequalities requires interventions tailored to the patient's socioeconomic context.