Patient Social Vulnerability And Hospital Community Racial/Ethnic Integration: Do All Patients Get The Same Care Across Hospitals?
*J. Madison Hyer, *Rayyan Mirdad, *Adrian Diaz, *Diamantis I Tsilimigras, *Djhenne Dalmacy, Timothy M Pawlik
The Ohio State University, Columbus, OH
OBJECTIVE(S): The interplay between patient- and community-level factors on outcomes following complex surgery has not been well-examined. We sought to characterize the role of patient vulnerability relative to hospital racial/ethnic integration on postoperative outcomes among patients undergoing pancreatectomy.
METHODS: Beneficiaries who underwent pancreatectomy between 2013-2017 were identified using Medicare data. Patient social vulnerability index(P-SVI) was determined using CDC criteria, while hospital racial/ethnic integration was estimated using Entropy Index(H-REI) from census estimates. P-SVI and H-REI impact on “textbook outcome”(TO)(i.e. no complication/extended length-of-stay/death/readmission) was assessed.
RESULTS: Among 24,500 beneficiaries who underwent pancreatectomy, 10,619(43.3%) patients achieved a TO. Incidence of TO was 41.1% versus 46.9% among patients from high social vulnerability areas treated at below-average versus above-average H-REI centers(p<0.001). TO varied widely based on P-SVI and H-REI (38%-50%)(Figure). Patients from high-SVI communities who underwent pancreatectomy in low H-REI hospitals had markedly lower odds of postoperative TO versus patients from low-SVI areas treated at hospitals in high H-REI areas(OR:0.58, 95%CI:0.44-0.76). In particular, patients who resided in high-SVI communities treated in hospitals located in low H-REI communities had increased odds of extended length-of-stay(OR:2.04; 95%CI:1.43-2.90) and 90-day mortality(OR:1.69; 95%CI:1.69-4.84).
CONCLUSIONS: Patients with high social vulnerability who underwent pancreatectomy in hospitals located in communities with low racial/ethnic integration had the lowest chance to achieve an “optimal” TO. A focus on both patient- and community-level factors is needed to ensure optimal patient outcomes.
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