Social determinants of health and surgical care

Díaz, Adrián; Pawlik, Timothy M.

doi:10.1016/j.cpsurg.2023.101300

Cited by 8 publications

(3 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…40 A growing body of literature has extensively reported associations between SDOH and surgical access, quality of treatment, recovery, and surgical outcomes (most commonly, morbidity and mortality). 41 Despite these reports, translating this research into effective clinical/surgical care (i.e., risk stratification and interventions) remains a challenge. Specific to CRS, SDOH-related factors have consistently been linked to worse postsurgical complications and readmissions.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…These disparities, studied across various health care domains, are critically important in surgical care, as even minor surgery can sometimes include serious risk . Moreover, SDOH are incredibly varied: Black patients can have 1.2 to 1.5 times higher surgical mortality vs White patients, patients living in areas labeled by the US Government Home Owners Loan Corporation as historically “hazardous” neighborhoods can have 1.19 times higher mortality than those living in areas labeled the “best” neighborhoods, and insurance type (means-tested insurance like Medicaid or no insurance) drives greater urgent and emergent surgical procedures, complications, readmissions, and lengths of hospital stay . All this prior work suggests that multiple SDOH need to be evaluated simultaneously, not in isolation, because SDOH can have independent effects or be heavily confounded with each other …”

Section: Introductionmentioning

confidence: 99%

“…2,3 These disparities, studied across various health care domains, are critically important in surgical care, 4 as even minor surgery can sometimes include serious risk. 5,6 Moreover, SDOH are incredibly varied: Black patients can have 1.2 to 1.5 times higher surgical mortality vs White patients, 4 patients living in areas labeled by the US Government Home Owners Loan Corporation as historically "hazardous" neighborhoods can have 1.19 times higher mortality than those living in areas labeled the "best" neighborhoods, 7 and insurance type (means-tested insurance like Medicaid or no insurance) drives greater urgent and emergent surgical procedures, 8 complications, 9 readmissions, 8,10 and lengths of hospital stay. 11 All this prior work suggests that multiple SDOH need to be evaluated simultaneously, not in isolation, because SDOH can have independent effects 12 or be heavily confounded with each other.…”

mentioning

confidence: 99%

Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans

Jacobs,

Gao,

Schmidt

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

ImportanceEvaluating how social determinants of health (SDOH) influence veteran outcomes is crucial, particularly for quality improvement.ObjectiveTo measure associations between SDOH, care fragmentation, and surgical outcomes using a Desirability of Outcome Ranking (DOOR).Design, Setting, And ParticipantsThis was a cohort study of US veterans using data from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP; 2013-2019) limited to patients aged 65 years or older with inpatient stays between 2 and 30 days, merged with multiple data sources, including Medicare. Race and ethnicity data were retrieved from VASQIP, Medicare and Medicaid beneficiary summary files, the Veterans Health Administration Corporate Data Warehouse, and the United States Veterans Eligibility Trends and Statistics file. Data were analyzed between September 2023 and February 2024.ExposureLiving in a highly deprived neighborhood (Area Deprivation Index &gt;85), race and ethnicity used as a social construct, rurality, and care fragmentation (percentage of non-VA care days).Main Outcomes and MeasuresDOOR is a composite, patient-centered ranking of 26 outcomes ranging from no complication (1, best) to 90-day mortality or near-death complications (6, worst). A series of proportional odds regressions was used to assess the impact of SDOH and care fragmentation adjusted for clinical risk factors, including presentation acuity (presenting with preoperative acute serious conditions and urgent or emergent surgical procedures).ResultsThe cohort had 93 644 patients (mean [SD] age, 72.3 [6.2] years; 91 443 [97.6%] male; 74 624 [79.7%] White). Veterans who identified as Black (adjusted odds ratio [aOR], 1.06; 95% CI, 1.02-1.10; P = .048) vs White and veterans with higher care fragmentation (per 20% increase in VA care days relative to all care days: aOR, 1.01; 95% CI, 1.01-1.02; P &lt; .001) were associated with worse (higher) DOOR scores until adjusting for presentation acuity. Living in rural geographic areas was associated with better DOOR scores than living in urban areas (aOR, 0.93; 95% CI, 0.91-0.96; P &lt; .001), and rurality was associated with lower presentation acuity (preoperative acute serious conditions: aOR, 0.88; 95% CI, 0.81-0.95; P = .001). Presentation acuity was higher in veterans identifying as Black, living in deprived neighborhoods, and with increased care fragmentation.Conclusions and RelevanceVeterans identifying as Black and veterans with greater proportions of non-VA care had worse surgical outcomes. VA programs should direct resources to reduce presentation acuity among Black veterans, incentivize veterans to receive care within the VA where possible, and better coordinate veterans’ treatment and records between care sources.

show abstract