Socioeconomic Influences on Short‐term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction

Abstract

Objective To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer. Study Design Retrospective review (2000-2019). Setting Single-institution tertiary medical center. Methods MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation. Results The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P = .022; β = −0.092, P = .045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]). Conclusion MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction.

Association of social vulnerability on survival, treatment, and presentation in oral cavity cancer

“…24 Prior studies have examined the association of geospatial characteristics with outcomes; however, these have been limited to smaller geographic regions. 25 While SVI was associated with outcomes in this study, the SES component of the SVI (composed of poverty characterization, unemployment, income, and high-school diploma) exhibited the strongest ability to predict compared to other themes within SVI, and possibly better than SVI itself. Interestingly, there was unexpectedly poor survival for those with more favorable and less vulnerable characteristics in terms of housing composition.…”

“…This study sought to determine the association of social factors with specific outcomes of oral cavity squamous cell carcinoma, which accounts for more than 90% of all oral cavity SCC 24 . Prior studies have examined the association of geospatial characteristics with outcomes; however, these have been limited to smaller geographic regions 25 . While SVI was associated with outcomes in this study, the SES component of the SVI (composed of poverty characterization, unemployment, income, and high‐school diploma) exhibited the strongest ability to predict compared to other themes within SVI, and possibly better than SVI itself.…”

Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

“…22,23 Within otolaryngology, ADI has been used to examine potential disparities following oral cavity cancer surgery and patient satisfaction in otolaryngology clinics. 24,25 Liao and colleagues demonstrated that ADI is correlated with increased length of stay and cost following pediatric tracheostomy, 26 whereas Cheung and colleagues were unable to find a significant association between ADI and outcomes following pediatric adenotonsillectomy for sleep disordered breathing. 27 There remain, however, no studies which have used the index to investigate inequities in deep-neck infections such as RPA.…”

“…Notable associations with ADI include increased rates of hospital readmission and increased incidence of COVID‐19 22,23 . Within otolaryngology, ADI has been used to examine potential disparities following oral cavity cancer surgery and patient satisfaction in otolaryngology clinics 24,25 . Liao and colleagues demonstrated that ADI is correlated with increased length of stay and cost following pediatric tracheostomy, 26 whereas Cheung and colleagues were unable to find a significant association between ADI and outcomes following pediatric adenotonsillectomy for sleep disordered breathing 27 .…”