The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center

Powers, Benjamin D.; Fulp, William J.; Dhahri, Amina; DePeralta, Danielle K.; Ogami, Takuya; Rothermel, Luke D.; Permuth, Jennifer B.; Vadaparampil, Susan T.; Kim, Joon-Kyung; Pimiento, José M.; Hodul, Pamela J.; Malafa, Mokenge P.; Anaya, Daniel A.; Fleming, Jason B.

doi:10.1097/sla.0000000000003706

Cited by 33 publications

(29 citation statements)

References 48 publications

(117 reference statements)

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“…They found no differences in surgical management, postoperative complications, or overall survival based on socioeconomic status as measured by the ADI in their surgical population. 10 The ADI has also been used in the orthopedic literature to examine differences in patient-reported outcomes around physical and mental well being after injuries. 20 The CNI has been used by Huang et al to predict emergency room visits after admission for trauma, demonstrating that patients with higher CNI had higher utilization of these resources after discharge.…”

Section: Resultsmentioning

confidence: 99%

“…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. 3,13,14 Characteristics of the four measures are described and compared in Table 1.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

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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“…In Power’s retrospective cohort analysis of 1,552 pancreatic adenocarcinoma patients undergoing curative-intent surgery, ADI was not associated with surgical complications or survival. 32 …”

Section: Discussionmentioning

confidence: 99%

Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes

Liu

Venkatesh

Hanlon

et al. 2021

Annals of Surgery Open

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Objective: To compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss. Background: The literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes. Methods: Patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2017 and had ≥1 year of follow-up within a large health system were included. Baseline characteristics, 90-day and 1-year outcomes, and weight loss were compared between Medicaid and non-Medicaid patients. Area deprivation index (ADI), urbanicity, and walkability were analyzed at the neighborhood level. Median regression with percent total body weight (TBW) loss as the outcome was used to assess predictors of weight loss after surgery. Results: Six hundred forty-seven patients met study criteria (191 Medicaid and 456 non-Medicaid). Medicaid patients had a higher 90-day readmission rate compared to non-Medicaid patients (19.9% vs 12.3%, P < 0.016). Weight loss was similar between Medicaid and non-Medicaid patients (23.1% vs 21.9% TBW loss, respectively; P = 0.266) at a median follow-up of 3.1 years. In adjusted analyses, Medicaid status, ADI, urbanicity, and walkability were not associated with weight loss outcomes. Conclusions: Medicaid status and social determinants of health at the neighborhood level were not associated with weight loss outcomes after bariatric surgery. These findings suggest that if Medicaid patients are appropriately selected for bariatric surgery, they can achieve equivalent outcomes as non-Medicaid patients.

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“…We performed a retrospective cohort study using a database of patients who underwent curative‐intent surgical resection for PDAC from 1 January 2008 to 31 December 2015 at the Moffitt Cancer Center. Our cohort included patients with anatomically resectable disease, which identified 243 patients, of whom 197 underwent curative‐intent surgery, as previously described 17 . All patients were assessed using an institutional clinical pathway and the NCCN guideline definition of borderline resectable PDAC was used throughout the study period 18 .…”

Section: Methodsmentioning

confidence: 99%

“…Our cohort included patients with anatomically resectable disease, which identified 243 patients, of whom 197 underwent curative-intent surgery, as previously described. 17 All patients were assessed using an institutional clinical pathway and the NCCN guideline definition of borderline resectable PDAC was used throughout the study period. 18 The evaluation included a multidisciplinary review of pancreatic protocol computed tomography imaging with or without computed tomography-positron emission tomography scan.…”

Section: Study Cohort and Settingmentioning

confidence: 99%

Cancer outcomes are independent of preoperative CA 19‐9 in anatomically resectable pancreatic ductal adenocarcinoma: A retrospective cohort analysis

Kim

DePeralta

Ogami

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Current guidelines recommend neoadjuvant therapy for pancreatic ductal adenocarcinoma (PDAC) patients with anatomically resectable tumors but elevated CA 19-9. However, this recommendation is based on data from anatomically resectable and borderline resectable PDAC patients. Therefore, we analyzed the association of preoperative CA 19-9 with oncologic outcomes in a cohort of anatomically resectable PDAC patients. Methods: A single-institution PDAC database from 2007 to 2015 included patients who underwent guideline-based staging and were anatomically resectable. Patients with bilirubin above 1.5 after decompression, nonsecretors of CA 19-9, and borderline resectable patients were excluded. Statistical analysis included frequency testing and regression modeling for recurrence and survival.

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The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center

Abstract: Supplemental Digital Content is available in the text

Cited by 33 publications

References 48 publications

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

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

Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes

Cancer outcomes are independent of preoperative CA 19‐9 in anatomically resectable pancreatic ductal adenocarcinoma: A retrospective cohort analysis

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