A socioecological qualitative analysis of barriers to care in colorectal surgery

Smith, Burkely P.; Girling, Isabel C.; Hollis, Robert H.; Rubyan, Michael; Shao, Connie; Jones, Bayley; Abbas, Alizeh; Herbey, Ivan; Oates, Gabriela R.; Pisu, Maria; Chu, Daniel I.

doi:10.1016/j.surg.2023.03.009

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…Although the SVI does capture a wide range of potentially important SDOH (such as minority status, English language proficiency, housing status, education, insurance status, and income 31 ), recent qualitative work suggests that additional SDOH (such as trust, communication, family and community support, and discrimination) may impact surgical care among colorectal surgery patients and may differ by race. 37 Therefore, a need exists for comprehensive tools capable of measuring a wide range of (previously underreported) SDOH in this patient population. The authors are currently conducting a detailed study at 3 rural hospitals in the state of Alabama on a wide range of SDOH at all socioecological levels.…”

Section: Discussionmentioning

confidence: 99%

Understanding the Impact of Enhanced Recovery Programs on Social Vulnerability, Race, and Colorectal Surgery Outcomes

Smith,

Katta,

Hollis

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Increasing social vulnerability measured by the social vulnerability index has been associated with worse surgical outcomes. However, less is known about social vulnerability’s impact on colorectal surgery patients under enhanced recovery programs. OBJECTIVE: We hypothesized that increasing social vulnerability is associated with worse outcomes prior to enhanced recovery implementation, but following implementation, disparities in outcomes would be reduced. DESIGN: Retrospective cohort study using multivariable logistic regression to identify associations of social vulnerability and enhanced recovery with outcomes. SETTINGS: Institutional American College of Surgeons-National Surgical Quality Improvement Program database. PATIENTS: Patients undergoing elective colorectal surgery (2010-2020). Enhanced recovery programs implemented in 2015. Those adhering to ≥70% of enhanced recovery program components defined as enhanced recovery and all others non-enhanced recovery. OUTCOMES: Length of stay, complications, and readmissions. RESULTS: Of 1,523 patients, 589 (38.7%) were in the enhanced recovery group, with 732 (40.3%) patients in the lowest third of social vulnerability index, 498 (27.4%) in the highest third, and no differences in social vulnerability index distribution by enhanced recovery group. On multivariable modeling, social vulnerability was not associated with increased length of stay, complications, or readmissions in either enhanced recovery group. Black race was associated with increased length of stay in both the non-enhanced recovery (OR 1.2, 95% CI, 1.1-1.3) and enhanced recovery groups (OR 1.2, 95% CI, 1.1-1.4). Enhanced recovery adherence was associated with reductions in racial disparities in complications as Black race was associated with increased odds of complications in the non-enhanced recovery (OR 1.9, 95% CI, 1.2-3.0) but not enhanced recovery group (OR 0.8, 95% CI, 0.4-1.6). LIMITATIONS: Details of potential factors affecting enhanced recovery program adherence was not assessed and is the subject of current work by this team. CONCLUSION: High social vulnerability was not associated with worse outcomes among both enhanced recovery and non-enhanced recovery colorectal patients. Enhanced recovery program adherence was associated with reductions in racial disparities in complication rates. However, disparities in length of stay remain and work is needed to understand the underlying mechanisms driving these disparities.

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Section: Discussionmentioning

confidence: 99%

Understanding the Impact of Enhanced Recovery Programs on Social Vulnerability, Race, and Colorectal Surgery Outcomes

Smith,

Katta,

Hollis

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

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“…43 Qualitative analysis of patients and other stakeholders in CRS has highlighted specific SDOH acting as barriers and facilitators to surgical care: provider communication, trust, and psychological stress (individual/interpersonal level), access to quality education materials, scheduling contacts, discrimination (organization level), community support and transportation (community level), and cost-sharing/coverage and advocacy (policy level). 44 Whether targeted SDOH assessment among at-risk individuals can reduce racial inequities in CRS outcomes by enabling effective interventions has yet to be established. 45 The ecological model shown in ►Fig.…”

Section: Social Determinants Of Healthmentioning

confidence: 99%

Achieving Health Equity: Advancing Colorectal Surgery among Racial and Ethnic Minorities in America

Overstreet,

Hollis

2024

Clin Colon Rectal Surg

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Racial inequities in short and long-term outcomes following colorectal surgery continue to persist. Using inflammatory bowel disease and colorectal cancer as disease foci, we review existing racial inequities in surgical outcomes and complications, discuss how social determinants of health and biopsychosocial factors can contribute to these inequities, and highlight potential mechanisms for building interventions to achieve health equity following colorectal surgery for minority populations.

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Providers’ and survivors’ perspectives on the availability and accessibility of surgery in gastrointestinal cancer care

English,

Ivankova,

Smith

et al. 2024

Journal of Gastrointestinal Surgery

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A socioecological qualitative analysis of barriers to care in colorectal surgery

Cited by 5 publications

References 33 publications

Understanding the Impact of Enhanced Recovery Programs on Social Vulnerability, Race, and Colorectal Surgery Outcomes

Understanding the Impact of Enhanced Recovery Programs on Social Vulnerability, Race, and Colorectal Surgery Outcomes

Achieving Health Equity: Advancing Colorectal Surgery among Racial and Ethnic Minorities in America

Providers’ and survivors’ perspectives on the availability and accessibility of surgery in gastrointestinal cancer care

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