He/Him/His
Job Title
Research Fellow
Academic Rank
Fellow or Postdoc
Department
Surgery
Surgical Oncology
Authors
Abolfazl Salari*, MD, Mengyuan Ruan, MS, Terhas Weldeslase, MD, MPH, Jiping Wang, MD, PhD, Joel S. Weissman, PhD, George Molina, MD, MPH
Categories
Tags
INTRODUCTION
Patient- and community-level sociodemographic factors have been found to be associated with access to cancer care and outcomes. Where patients receive care also has impact on the quality of care they receive. The objective of this study was to evaluate whether the contribution of Social Determinants of Health (SDoH) to short-term surgical outcomes persists when hospital quality is added to predictive models.
METHODS
This retrospective study evaluated 30-day mortality and readmission among Medicare beneficiaries (age ≥ 65) who underwent selected elective cancer surgery between 2016-2018. We used two measures of SDoH: 1) Social Vulnerability Index (SVI), measured on a scale from 0 (least vulnerable) to 1 (most vulnerable); and 2) Distressed Communities Index (DCI), which categorized patients into five groups: prosperous, comfortable, mid-tier, at risk, and distressed. The CMS Overall Hospital Star Rating ranged from 1 (worst) to 5 (best). Short-term outcomes were evaluated using separate multivariable logistic regression models that sequentially adjusted for comorbidities and each SDoH (Model 1 and 3) and then the Hospital Rating (Model 2 and 4).
RESULTS
Among 16,869 patients that met inclusion criteria, 12.5%, 14.8%, 24.1%, and 48.6% underwent esophagectomy, gastrectomy, liver resection, or pancreatectomy, respectively. In Models 1 and 3, the “At Risk” DCI group and higher SVI were associated with higher 30-day mortality, and SVI was associated with 30-day readmission (OR 1.17, 95% CI 1.01-1.36, p=0.03). In Model 2, Hospital Rating was significantly associated with 30-day mortality and readmission. Neither SDoH index attained statistical significance in Models 2 and 4.
CONCLUSIONS
The significant associations between DCI/SVI and 30-day mortality and readmission following elective cancer surgery disappeared after adjusting for hospital quality. This suggests that the quality of the hospital where patients undergo surgery appears to have a greater impact than community-level SDoH factors on short-term outcomes after elective cancer surgery.
