Associations Between Social Risk Factors and Surgical Site Infections After Colectomy and Abdominal Hysterectomy

Peacock, Kate; Luke, Alina A.; Barker, Abigail; Olsen, Margaret A.; Maddox, Karen E. Joynt

doi:10.1001/jamanetworkopen.2019.12339

Cited by 24 publications

(26 citation statements)

References 16 publications

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“…There is a well‐established link between low socioeconomic status and increased morbidity and mortality 1–3 . In the United States (US), patients with a low socioeconomic status have higher rates of postoperative complications, mortality, failure to rescue and readmissions 4–14 . Some studies suggest that these disparities may be attributable to inequalities in the US healthcare system, rather than differential treatment of patients within individual care settings 9,15 .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] In the United States (US), patients with a low socioeconomic status have higher rates of postoperative complications, mortality, failure to rescue and readmissions. [4][5][6][7][8][9][10][11][12][13][14] Some studies suggest that these disparities may be attributable to inequalities in the US healthcare system, rather than differential treatment of patients within individual care settings. 9,15 Hospitals disproportionately treating patients with lower socioeconomic status have worse outcomes when compared to other hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in surgical outcomes for low socioeconomic status patients in Australia

Jager

Gunnarsson

2022

ANZ Journal of Surgery

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Background: There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self-reported unemployment and neighbourhood level socioeconomic status in Australia. Methods: A retrospective administrative data review was conducted at a tertiary care centre over a 10-year period (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed. Results: 106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50-2.82), OR 1.37 (1.15-1.64)), all complications ), OR 1.21 (1.14-1.28)), failure to rescue )) and return to theatre , OR 1.24 (1.14-1.36)) (P < 0.005 for all). Conclusions: Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in surgical outcomes for low socioeconomic status patients in Australia

Jager

Gunnarsson

2022

ANZ Journal of Surgery

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“…There are various factors that may play a role in our findings—INCan is a high‐volume, academic teaching hospital (consequently, ambulatory breast procedures are commonly performed). As a learning center with a substantial patient burden, it serves several regions (both urban and rural) of the country, where the population often has limited resources and education—factors that weigh importantly on postoperative outcomes 24,25 …”

Section: Discussionmentioning

confidence: 99%

Inadequate prediction of postoperative complications in breast cancer surgery: An evaluation of the ACS Surgical Risk Calculator

Gonzalez-Woge

Martín-Tellez

Gonzalez-Woge

et al. 2021

Journal of Surgical Oncology

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Background The American College of Surgeon (ACS) Surgical Risk Calculator is an online tool that helps surgeons estimate the risk of postoperative complications for numerous surgical procedures across several surgical specialties. Methods We evaluated the predictive performance of the calculator in 385 cancer patients undergoing breast surgery. Calculator‐predicted complication rates were compared with observed complication rates; calculator performance was evaluated using calibration and discrimination analyses. Results The mean calculator‐predicted rates for any complication (4.1%) and serious complication (3.2%) were significantly lower than the observed rates (11.2% and 5.2%, respectively). The area under the curve was 0.617 for any complication and 0.682 for serious complications. p Values for the Hosmer–Lemeshow test were significant (<.05) for both outcomes. Brier scores were 0.102 for any complication and 0.048 for serious complication. Conclusions The ACS risk calculator is not an ideal tool for predicting individual risk of complications following breast surgery in a Mexican cohort. The most valuable use of the calculator may reside in its role as an aid for patient‐led surgery planning. The possibility of introducing breast surgery‐specific data could improve the performance of the calculator. Furthermore, a disease‐specific calculator could provide more accurate predictions and include complications more frequently found in breast cancer surgery.

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“…Much of the literature has concentrated on perioperative bundles aimed at decreasing SSI rates in gynecological and colorectal surgeries 19,20 . We present a large study comprising 2875 obstetric patients and a standardized comprehensive SSI prevention bundle instituted specific to cesarean births.…”

Section: Discussionmentioning

confidence: 99%

Decreased incidence of cesarean surgical site infection rate with hospital‐wide perioperative bundle

Sood

Lee

et al. 2021

Birth

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Background Reduction in the incidence of surgical site infection (SSI) serves as a measure of patient safety and quality improvement. Cesarean birth (CB) accounts for 31.9% of all childbirths in the United States. However, our understanding of SSI prevention bundles predominantly stems from gynecological and colorectal surgeries. This study aimed to determine the efficacy of a standardized perioperative bundle designed to reduce SSI in CBs. Methods All CB patients at Flushing Hospital Medical Center from 2017 to 2019 were included in a retrospective analysis. Patients were divided into three groups based on the timing of intervention: prebundle/control, transition, and postbundle. Baseline demographics and clinical characteristics were summarized using descriptive statistics. Multiple logistic regression was performed to determine the association between bundle group and SSI, considering variables different between groups at baseline (P < 0.10). Results Two thousand eight hundred and seventy‐five CBs were performed: 1086 in prebundle, 812 in transition, and 977 in postbundle phase. In the prebundle phase, 25 CBs (2.3%) were complicated by SSIs; in the transition phase, 10 (1.2%) had SSIs; and in the postbundle phase, 7 (0.7%; P = 0.009) had SSIs. In a logistic regression model, only use of the CB bundle (OR 0.26 [95% CI 0.07‐0.94]; P = 0.04), rupture of membranes (0.29 [0.09‐0.87]; P = 0.03), and operating room time (1.02 [1.01‐1.04]; P = 0.01) were significant in prediction of SSI. SSI postbundle was significantly reduced from prebundle (0.04). Conclusions Thus, introduction of a hospital‐wide perioperative bundle significantly reduced SSI rates, and should be developed as a mainstay of CB surgical care.

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Associations Between Social Risk Factors and Surgical Site Infections After Colectomy and Abdominal Hysterectomy

Cited by 24 publications

References 16 publications

Disparities in surgical outcomes for low socioeconomic status patients in Australia

Disparities in surgical outcomes for low socioeconomic status patients in Australia

Inadequate prediction of postoperative complications in breast cancer surgery: An evaluation of the ACS Surgical Risk Calculator

Decreased incidence of cesarean surgical site infection rate with hospital‐wide perioperative bundle

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