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Journal of Gastrointestinal Surgery

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01-03-2021 | Colectomy | Original Article

Association of County-Level Social Vulnerability with Elective Versus Non-elective Colorectal Surgery

Authors: Adrian Diaz, Elizabeth Barmash, Rosevine Azap, Anghela Z. Paredes, J. Madison Hyer, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 3/2021

Abstract

Introduction

A person’s community, or lived environment, may play an important role in achieving optimal health outcomes. The objective of the current study was to assess the association of county-level vulnerability with the probability of having a non-elective colon resection. We hypothesized that individuals from areas with a high social vulnerability would be at greater risk of non-elective colon resection compared with patients from low social vulnerability areas.

Methods

Patients aged 65–99 who underwent a colon resection for a primary diagnosis of either diverticulitis (n = 11,812) or colon cancer (n = 33,312) were identified in Medicare Part A and Part B for years 2016–2017. Logistic regression analysis was used to evaluate differences in probability of undergoing an elective versus non-elective operation from counties relative to county-level social vulnerability index (SVI). Secondary outcomes included postoperative complications, mortality, readmission, and index hospitalization expenditure.

Results

Among 45,124 patients, 11,812 (26.2%) underwent a colon resection for diverticulitis, while 33,312 (73.8%) had a resection for colon cancer; 31,012 (68.7%) patients had an elective procedure (diverticulitis n = 7291 (61.7%) vs. cancer n = 23,721 (71.2%)), while 14,112 (31.3%) had an emergent operation (diverticulitis n = 4521 (38.3%) vs. cancer n = 9591 (28.8%)). Patients with a high SVI were more likely to undergo an emergent colon operation compared with low SVI patients (43.7% vs. 40.4%) (p < 0.001). The association of high SVI with increased risk of an emergent colon operation was similar among patients with diverticulitis (emergent: low SVI 37.2% vs. high SVI 40.4%) or colon cancer (emergent: low SVI 26.0% vs. high SVI 29.9%) (both p < 0.05). On multivariable analyses, risk-adjusted probability of undergoing an urgent/emergent operation remained associated with SVI (p < 0.05).

Conclusion

Patients residing in vulnerable communities characterized by a high SVI were more likely to undergo a non-elective colon resection for either diverticulitis or colon cancer. Patients from high SVI areas had a higher risk of postoperative complications, as well as index hospitalization expenditures; however, there were no differences in mortality or readmission rates.

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Levy H, Janke A. Health literacy and access to care. J Health Commun. 2016;21 Suppl 1:43-50. doi:https://doi.org/10.1080/10810730.2015.1131776CrossRefPubMedPubMedCentral

Schoen C, Osborn R, Squires D, Doty MM. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Aff Proj Hope. 2013;32(12):2205-2215. doi:https://doi.org/10.1377/hlthaff.2013.0879CrossRef

Collins SR, Gunja MZ, Doty MM, Beutel S. Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction. Published May 25, 2016. Accessed April 20, 2017. http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction.

Diaz A, Schoenbrunner A, Pawlik TM. Trends in the Geospatial Distribution of Inpatient Adult Surgical Services across the United States: Ann Surg. Published online May 2019:1. https://doi.org/10.1097/SLA.0000000000003366

Kind AJH, Buckingham WR. Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas. N Engl J Med. 2018;378(26):2456-2458. doi:https://doi.org/10.1056/NEJMp1802313CrossRefPubMedPubMedCentral

Kolak M, Bhatt J, Park YH, Padrón NA, Molefe A. Quantification of Neighborhood-Level Social Determinants of Health in the Continental United States. JAMA Netw Open. 2020;3(1):e1919928. doi:https://doi.org/10.1001/jamanetworkopen.2019.19928CrossRefPubMedPubMedCentral

Arcaya M, Tucker-Seeley R, Kim R, Schnake-Mahl A, So M, Subramanian S. Research on Neighborhood Effects on Health in the United States: A Systematic Review of Study Characteristics. Soc Sci Med 1982. 2016;168:16 29. doi:https://doi.org/10.1016/j.socscimed.2016.08.047CrossRef

Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep Wash DC 1974. 2001;116(5):404-416. doi:https://doi.org/10.1093/phr/116.5.404CrossRef

Chetty R, Hendren N, Katz LF. The Effects of Exposure to Better Neighborhoods on Children: New Evidence from the Moving to Opportunity Experiment. Am Econ Rev. 2016;106(4):855-902. doi:https://doi.org/10.1257/aer.20150572CrossRefPubMed

10.

Sharkey P. Neighborhoods, Cities, and Economic Mobility. RSF Russell Sage Found J Soc Sci. 2016;2(2):159-177. doi:https://doi.org/10.7758/RSF.2016.2.2.07CrossRef

11.

McGinnis JM. Income, Life Expectancy, and Community Health: Underscoring the Opportunity. JAMA. 2016;315(16):1709-1710. doi:https://doi.org/10.1001/jama.2016.4729CrossRefPubMed

12.

Branas CC, MacKenzie EJ, Williams JC, et al. Access to Trauma Centers in the United States. JAMA. 2005;293(21):2626-2633. doi:https://doi.org/10.1001/jama.293.21.2626CrossRefPubMed

13.

Jarman MP, Curriero FC, Haut ER, Porter KP, Castillo RC. Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality. JAMA Surg. 2018;153(6):535-543. doi:https://doi.org/10.1001/jamasurg.2017.6133CrossRefPubMedPubMedCentral

14.

Anaya DA, Flum DR. Risk of Emergency Colectomy and Colostomy in Patients With Diverticular Disease. Arch Surg. 2005;140(7):681-685. doi:https://doi.org/10.1001/archsurg.140.7.681CrossRefPubMed

15.

Aslar AK, Özdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 Cases of Emergent Surgery for Obstructing Colon Cancer—Lessons Learned. J Gastrointest Surg. 2011;15(1):110-119. doi:https://doi.org/10.1007/s11605-010-1360-2CrossRefPubMed

16.

Sjo OH, Larsen S, Lunde OC, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009;11(7):733-739. doi:https://doi.org/10.1111/j.1463-1318.2008.01613.xCrossRefPubMed

17.

CDC’s Social Vulnerability Index. Published September 5, 2018. Accessed March 14, 2020. https://svi.cdc.gov/

18.

Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496-504. doi:https://doi.org/10.1001/jama.2015.25CrossRefPubMedPubMedCentral

19.

Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700-715. doi:https://doi.org/10.1097/00005650-199407000-00004CrossRefPubMed

20.

Paredes AZ, Hyer JM, Beal EW, et al. Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery. Surgery. 2019;166(1):1-7. doi:https://doi.org/10.1016/j.surg.2018.12.008CrossRefPubMed

21.

Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP. Disparities in access to emergency general surgery care in the United States. Surgery. 2018;163(2):243-250. doi:https://doi.org/10.1016/j.surg.2017.07.026CrossRefPubMed

22.

Zogg CK, Scott JW, Jiang W, Wolf LL, Haider AH. Differential access to care: The role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates. Surgery. 2016;160(5):1145-1154. doi:https://doi.org/10.1016/j.surg.2016.06.002CrossRefPubMed

23.

Bennett KM, Scarborough JE, Pappas TN, Kepler TB. Patient socioeconomic status is an independent predictor of operative mortality. Ann Surg. 2010;252(3):552-557; discussion 557-558. doi:https://doi.org/10.1097/SLA.0b013e3181f2ac64CrossRefPubMed

24.

Mehaffey JH, Hawkins RB, Charles EJ, et al. Socioeconomic “Distressed Communities Index” Improves Surgical Risk-adjustment: Ann Surg. 2020;271(3):470-474. doi:https://doi.org/10.1097/SLA.0000000000002997CrossRefPubMed

25.

Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74-81. doi:https://doi.org/10.1016/j.amepre.2008.09.025CrossRefPubMed

26.

Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health Place. 2010;16(5):876-884. doi:https://doi.org/10.1016/j.healthplace.2010.04.013CrossRefPubMed

27.

Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health. 2014;104(9):1734-1741. doi:https://doi.org/10.2105/AJPH.2014.302003CrossRefPubMedPubMedCentral

28.

Williams DR, Costa MV, Odunlami AO, Mohammed SA. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. J Public Health Manag Pract JPHMP. 2008;14(Suppl):S8-17. doi:https://doi.org/10.1097/01.PHH.0000338382.36695.42CrossRefPubMed

29.

Thornton RLJ, Glover CM, Cené CW, Glik DC, Henderson JA, Williams DR. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff Proj Hope. 2016;35(8):1416-1423. doi:https://doi.org/10.1377/hlthaff.2015.1357CrossRef

30.

An R, Xiang X. Social Vulnerability and Obesity among U.S. Adults. Int J Health Sci IJHS. 2015;3(3). doi:https://doi.org/10.15640/ijhs.v3n3a2

31.

Yee CW, Cunningham SD, Ickovics JR. Application of the Social Vulnerability Index for Identifying Teen Pregnancy Intervention Need in the United States. Matern Child Health J. 2019;23(11):1516-1524. doi:https://doi.org/10.1007/s10995-019-02792-7CrossRefPubMed

32.

Carmichael H, Moore A, Steward L, Velopulos CG. Using the Social Vulnerability Index to Examine Local Disparities in Emergent and Elective Cholecystectomy. J Surg Res. 2019;243:160-164. doi:https://doi.org/10.1016/j.jss.2019.05.022CrossRefPubMed

33.

Wilson K d’Almeida, Dray-Spira R, Aubrière C, et al. Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France. AIDS Care. 2014;26 Suppl 1:S83-93. doi:https://doi.org/10.1080/09540121.2014.906554CrossRef

34.

Fraser S, Bunce C, Wormald R, Brunner E. Deprivation and late presentation of glaucoma: case-control study. BMJ. 2001;322(7287):639-643. doi:https://doi.org/10.1136/bmj.322.7287.639CrossRefPubMedPubMedCentral

35.

Kurani SS, McCoy RG, Lampman MA, et al. Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest. JAMA Netw Open. 2020;3(3):e200618. doi:https://doi.org/10.1001/jamanetworkopen.2020.0618CrossRefPubMedPubMedCentral

36.

Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for Diverticulitis in the 21st Century: A Systematic Review. JAMA Surg. 2014;149(3):292-303. doi:https://doi.org/10.1001/jamasurg.2013.5477CrossRefPubMed

37.

Koperna T, Kisser M, Schulz F. Emergency Surgery for Colon Cancer in the Aged. Arch Surg. 1997;132(9):1032-1037. doi:https://doi.org/10.1001/archsurg.1997.01430330098018CrossRefPubMed

38.

Scott JW, Olufajo OA, Brat GA, et al. Use of National Burden to Define Operative Emergency General Surgery. JAMA Surg. 2016;151(6):e160480. doi:https://doi.org/10.1001/jamasurg.2016.0480CrossRefPubMed

39.

Lavanchy JL, Vaisnora L, Haltmeier T, et al. Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis. 2019;34(12):2091-2099. doi:https://doi.org/10.1007/s00384-019-03426-8CrossRefPubMed

40.

Soyalp C, Yuzkat N, Kilic M, Akyol ME, Demir CY, Gulhas N. Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. Aging Clin Exp Res. 2019;31(3):403-410. doi:https://doi.org/10.1007/s40520-018-0976-zCrossRefPubMed

41.

Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531-537. doi:https://doi.org/10.1016/j.jamcollsurg.2004.05.276CrossRefPubMed

42.

Healy MA, Mullard AJ, Campbell DA, Dimick JB. Hospital and Payer Costs Associated With Surgical Complications. JAMA Surg. 2016;151(9):823-830. doi:https://doi.org/10.1001/jamasurg.2016.0773CrossRefPubMed

43.

Thomas-Henkel C, Schulman M. Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations. Center for Health Care Stradegies Inc.; 2017:10. http://www.chcs.org/media/SDOH-Complex-Care-Screening-Brief-102617.pdf

Title: Association of County-Level Social Vulnerability with Elective Versus Non-elective Colorectal Surgery
Authors: Adrian Diaz
Elizabeth Barmash
Rosevine Azap
Anghela Z. Paredes
J. Madison Hyer
Timothy M. Pawlik
Publication date: 01-03-2021
Publisher: Springer US
Keywords: Colectomy
Colectomy
Diverticulitis
Colon Cancer
Colon Cancer
Published in: Journal of Gastrointestinal Surgery / Issue 3/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-020-04768-3

At a glance: The STEP trials

Springer Medicine

Association of County-Level Social Vulnerability with Elective Versus Non-elective Colorectal Surgery

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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