Cholecystectomy: Exploring the Interplay Between Access to Care and Emergent Presentation

Moore, Allison; Carmichael, Heather; Steward, Lauren; Velopulos, Catherine G.

doi:10.1016/j.jss.2019.06.070

Cited by 17 publications

(13 citation statements)

References 20 publications

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“…Diaz et al 34 noted that patients living in counties with the greatest degree of social vulnerability had a nearly 20% higher odds of nonelective surgery for colon cancer and diverticulitis when compared with patients living in the least vulnerable communities. Similarly, Carmichael and colleagues 35 demonstrated that individuals from communities of high social vulnerability have more than two-fold greater odds of undergoing emergent cholecystectomy versus an elective procedure, 34 with lack of health insurance or primary care provider, as well as transportation and language barrier issues implicated as contributing factors to emergent presentation 35–37 . Additional work has shown individuals living in areas of greater socioeconomic deprivation to be less likely to undergo recommended screening for breast, cervical, and colorectal cancer, highlighting potential issues associated with access to basic medical care 38 …”

Section: Discussionmentioning

confidence: 99%

Socioeconomic disadvantage is associated with greater mortality after high-risk emergency general surgery

Cain

Horns

Huang

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Socioeconomic disadvantage is associated with worse outcomes after elective surgery, but the effect on emergency general surgery (EGS) remains unclear. We examined the association of socioeconomic disadvantage and outcomes after EGS procedures and investigated whether admission to hospitals with comprehensive clinical and social resources mitigated this effect. METHODS:Adults undergoing 1 of the 10 most burdensome high-and low-risk EGS procedures were identified in six 2014 State Inpatient Databases. Socioeconomic disadvantage was assessed using Area Deprivation Index (ADI) of patient residence. Multivariable logistic regression models adjusting for patient and hospital factors were used to evaluate the association between ADI quartile (high >75 percentile vs. low <25 percentile), and 30-day readmission, in-hospital mortality, and discharge disposition. Effect modification between ADI and (a) level 1 trauma center and (b) safety-net hospital status was tested. RESULTS:A total of 103,749 patients were analyzed: 72,711 low-risk (70.1%) and 31,038 high-risk procedures (29.9%). Patients from neighborhoods with high socioeconomic disadvantage had a higher proportion with ≥3 comorbidities (41.9% vs. 32.0%), minority race/ ethnicity (66.3% vs. 42.4%), and Medicaid (28.8% vs. 14.7%) and were less likely to be treated at level 1 trauma centers (18.3% vs. 27.7%; p < 0.001 for all). Adjusting for competing factors, high socioeconomic disadvantage was associated with increased inhospital mortality after high-risk procedures (odd ratio, 1.30; 95% confidence interval, 1.01-1.66; p = 0.04) and higher odds of non-home discharge (odd ratio, 1.15; 95% confidence interval, 1.02-1.30; p = 0.03) for low-risk procedures. Socioeconomic disadvantage was not associated with 30-day readmission for either procedure group. Level 1 trauma status and safety-net hospital did not meaningfully mitigate effect of ADI for any outcome. CONCLUSION:Socioeconomic disadvantage is associated with increased mortality after high-risk procedures and higher odds of non-home discharge after low-risk procedures. This effect was not mitigated by either level 1 trauma or safety-net hospitals. Interventions that specifically address the needs of socially vulnerable communities will be required to significantly improve EGS outcomes for this population.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic disadvantage is associated with greater mortality after high-risk emergency general surgery

Cain

Horns

Huang

et al. 2022

J Trauma Acute Care Surg

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“…Most studies have confirmed that the lack of preoperative communication with patients is one of the main reasons for their increased fear and anxiety. Consequently, their cooperation with anesthesia will be reduced, affecting the surgical effect [ 17 – 19 ]. Therefore, it is necessary to improve the perioperative nursing measures for patients undergoing laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Effects of Individualized Nursing Based on Zero-Defect Theory on Perioperative Patients Undergoing Laparoscopic Cholecystectomy

Lan

Zhu

et al. 2022

Disease Markers

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Objective. This study is aimed at analyzing the effects of individualized nursing based on the zero-defect theory on perioperative patients undergoing laparoscopic cholecystectomy. Methods. 174 patients who underwent laparoscopic cholecystectomy from 1st November 2019 to 30th November 2020 were enrolled as the research subjects and randomly divided into control and observation groups. The patients in the control group received conventional perioperative nursing care, and the patients in the observation group were treated with individualized nursing based on the zero-defect theory. Results. The heart rate, diastolic blood pressure, and systolic blood pressure level of patients in two groups after nursing decreased significantly, and the reduction in the observation group was more significant than that in the control group. The depression and anxiety scores of the two groups after nursing were decreased, and the decrease in the observation group was significantly greater than that in the control group. The time to first postoperative exhaust, return to normal intake, out-of-bed activity, and hospital stay in the observation group was less than that in the control group. The incidence of postoperative complications in the observation group was substantially lower than that in the control group. The satisfaction degree of nursing care in the observation group was significantly higher than that in the control group. Conclusion. Individualized nursing care based on zero-defect theory can effectively reduce the perioperative psychological stress response of patients with laparoscopic cholecystectomy. It helps to improve the negative emotions of depression and anxiety, promotes the recovery of disease, reduces postoperative complications, and improves nursing satisfaction, which is worthy of clinical promotion.

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“…Underscoring that factors more specific than race, income, and insurance status affect access to care, we conducted a more in-depth study evaluating qualitative data around barriers to care, finding that issues such as mistrust of the medical system, fear around access to adequate pain medication, and transportation to appointments play a major role even when patients have some type of insurance. 9 The SVI is not the only measure of social vulnerability that is being used in the surgical outcomes literature. [10][11][12] This study assesses the performance of the SVI as compared with three similar measures: the Area Deprivation Index (ADI), Community Needs Index (CNI), and Distressed Communities Index (DCI), which are measured at the census block group and zip code level, respectively.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Emergency Versus Elective Surgery: Comparing Measures of Neighborhood Social Vulnerability

Carmichael¹,

Moore

Steward³

et al. 2020

Journal of Surgical Research

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Background: Several composite measures of neighborhood social vulnerability exist and are used in the health disparity literature. This study assesses the performance of the Social Vulnerability Index (SVI) compared with three similar measures used in the surgical literature: Area Deprivation Index (ADI), Community Needs Index (CNI), and Distressed Communities Index (DCI). There are advantages of the SVI over these other scales, and we hypothesize that it performs equivalently. Methods:We identified all cholecystectomies at a single, urban, academic hospital over a 9month period. Cases were considered emergency if the patient presented and underwent surgery during that admission. We geocoded patient's addresses and assigned estimated SVI, ADI, CNI, and DCI. Cutoffs for high versus low social vulnerability were generated using Youden's index, and the scales were compared using multivariable modeling.Results: Overall, 366 patients met inclusion criteria, and the majority (n ¼ 266, 73%) had surgery in the emergency setting. On multivariable modeling, patients with high social vulnerability were more likely to undergo emergency surgery compared with those with low social vulnerability in accordance with all four scales: SVI (OR 3.24, P < 0.001), ADI (OR 3.2, P < 0.001), CNI (OR 1.90, P ¼ 0.04), and DCI (OR 2.01, P ¼ 0.03). The scales all had comparable predictive value. Conclusions:The SVI performs similarly to other indices of neighborhood vulnerability in demonstrating disparities between emergency and elective surgery and is readily available and updated. Because the SVI has multiple subcategories in addition to the overall measure, it can be used to stratify by modifiable factors such as housing or transportation to inform interventions.

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Cholecystectomy: Exploring the Interplay Between Access to Care and Emergent Presentation

Cited by 17 publications

References 20 publications

Socioeconomic disadvantage is associated with greater mortality after high-risk emergency general surgery

Socioeconomic disadvantage is associated with greater mortality after high-risk emergency general surgery

Effects of Individualized Nursing Based on Zero-Defect Theory on Perioperative Patients Undergoing Laparoscopic Cholecystectomy

Disparities in Emergency Versus Elective Surgery: Comparing Measures of Neighborhood Social Vulnerability

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