Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries.
Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries.
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医疗保险受益人的社会脆弱性和紧急普通手术。
DOI：
10.1097/xcs.0000000000000429
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发表时间：
2023
影响因子：
5.2
通讯作者：
Ibrahim,AndrewM
中科院分区：
文献类型：
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作者：
Zhang,Yuqi;Kunnath,Nicholas;Dimick,JustinB;Scott,JohnW;Ibrahim,AndrewM
背景：虽然社会脆弱性指数（SVI）是为了识别意外自然灾害后的弱势群体而创建的，但其识别接受意外紧急外科手术的类似患者群体的能力尚不清楚。我们试图探讨 SVI 与急诊普通手术后结果之间的关系。 研究设计：本研究是对 887,193 名医疗保险受益人的横断面回顾，这些受益人在 2014 年至 2018 年间接受了 4 种常见急诊普通外科手术（阑尾切除术、胆囊切除术、结肠切除术和腹疝修复术）中的一种。人口普查追踪居住水平。使用逻辑回归模型评估风险调整结果（30 天死亡率、严重并发症、再入院），该模型考虑了高社会脆弱性五分位和低社会脆弱性五分位之间的年龄、性别、合并症、年份、手术类型和医院特征以及 4 个 SVI 子主题（社会经济地位、家庭组成和残疾、少数群体状况和语言、住房类型和交通）。 结果：与社会脆弱性较低的受益人相比，居住在社会脆弱性较高的地区的 30 天死亡率较高（8.56% vs 8.08%；调整后优势比 1.07；p< 0.001）、严重并发症（20.71% vs 18.40%；调整后优势比 1.17；p<0.001）和再入院率较高（16.09% vs 15.03%；调整后优势比 1.08； p < 0.001）。这种不同结果的模式出现在所有 4 个 SVI 子主题的亚组分析中，但在社会经济地位、家庭构成和残疾子主题中最为明显。 结论：国家为支持自然灾害中社会脆弱性较高的患者所做的努力可能与确定特别容易遭受急诊普外科手术后更差术后结果的社区的努力非常一致。针对与家庭构成和社会经济地位相关的结构性障碍的政策可能有助于缓解这些差距。
BACKGROUND:Although the Social Vulnerability Index (SVI) was created to identify vulnerable populations after unexpected natural disasters, its ability to identify similar groups of patients undergoing unexpected emergency surgical procedures is unknown. We sought to examine the association between SVI and outcomes after emergency general surgery.STUDY DESIGN:This study is a cross-sectional review of 887,193 Medicare beneficiaries who underwent 1 of 4 common emergency general surgery procedures (appendectomy, cholecystectomy, colectomy, and ventral hernia repair) performed in the urgent or emergent setting between 2014 and 2018. These data were merged with the SVI at the census-track level of residence. Risk-adjusted outcomes (30-day mortality, serious complications, readmission) were evaluated using a logistic regression model accounting for age, sex, comorbidity, year, procedure type, and hospital characteristics between high and low social vulnerability quintiles and within the 4 SVI subthemes (socioeconomic status; household composition and disability; minority status and language; and housing type and transportation).RESULTS:Compared with beneficiaries with low social vulnerability, Medicare beneficiaries living in areas of high social vulnerability experienced higher rates of 30-day mortality (8.56% vs 8.08%; adjusted odds ratio 1.07; p< 0.001), serious complications (20.71% vs 18.40%; adjusted odds ratio 1.17; p< 0.001), and readmissions (16.09% vs 15.03%; adjusted odds ratio 1.08; p< 0.001). This pattern of differential outcomes was present in subgroup analysis of all 4 SVI subthemes but was greatest in the socioeconomic status and household composition and disability subthemes.CONCLUSIONS:National efforts to support patients with high social vulnerability from natural disasters may be well aligned with efforts to identify communities that are particularly vulnerable to worse postoperative outcomes after emergency general surgery. Policies targeting structural barriers related to household composition and socioeconomic status may help alleviate these disparities.