Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home

Abstract

Objective: To evaluate whether patients of Black race are at higher risk of adverse postoperative discharge to a nursing home, and if a higher prevalence of severe diabetes mellitus and hypertension are contributing. Background: It is unclear whether a patient's race predicts adverse discharge to a nursing home after surgery, and if preexisting diseases are contributing. Methods: A total of 368,360 adults undergoing surgery between 2007 and 2020 across 2 academic healthcare networks in New England were included. Patients of self-identified Black or White race were compared. The primary outcome was postoperative discharge to a nursing facility. Mediation analysis was used to examine the impact of preexisting severe diabetes mellitus and hypertension on the primary association.Results: In all, 10.3% (38,010/368,360) of patients were Black and 26,434 (7.2%) patients were discharged to a nursing home. Black patients were at increased risk of postoperative discharge to a nursing facility (adjusted absolute risk difference: 1.9%; 95% confidence interval: 1.6%-2.2%; P < 0.001). A higher prevalence of preexisting severe diabetes mellitus and hypertension in Black patients mediated 30.2% and 15.6% of this association. Preoperative medication-based treatment adherent to guidelines in patients with severe diabetes mellitus or hypertension mitigated the primary association (P-for-interaction <0.001). The same pattern of effect mitigation by pharmacotherapy was observed for the endpoint 30-day readmission. Conclusions: Black race was associated with postoperative discharge to a nursing facility compared to White race. Optimized preoperative assessment and treatment of diabetes mellitus and hypertension improves surgical outcomes and provides an opportunity to the surgeon to help eliminate healthcare disparities.

Prevalence and association of non-medical cannabis use with post-procedural healthcare utilisation in patients undergoing surgery or interventional procedures: a retrospective cohort study

“…We then conducted the primary analysis to test the research hypothesis that cannabis use, differentiated into patients with a cannabis use disorder and patients with reported ongoing non-medical cannabis use, is associated with advanced post-procedural healthcare utilisation using multivariable logistic regression analyses. Advanced post-procedural healthcare utilisation 23 was defined as a composite outcome consisting of non-home discharge (post-procedural discharge to a skilled nursing home or long-term care facility), 24 , 25 , 26 , 27 30-day hospital readmission, 28 or seven-day unplanned ICU admission. 29 Patients who died within the hospital stay of the index procedure were considered as having the outcome.…”

“…The a priori defined primary confounder model included patient baseline characteristics, multiple socioeconomic factors including estimated household income, 25 , 27 preoperative factors, as well as pre-existing physical and psychiatric comorbidities, along with concomitant substance use disorders. We also adjusted the analysis for the year in which the procedure was performed, the type of anaesthesia (general anaesthesia or monitored anaesthesia care), duration of surgery, and the Charlson Comorbidity Index.…”