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Geographic Proximity of Family Members and Healthcare Utilization after Complex Surgical Procedures
Brian T. Bucher1, Meng Yang1, Rebecca Steed2, Alison Frasier2, Samuel Finlayson1, Heidi Hanson1
1Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States, 2Utah Population Database, Huntsman Cancer Institute, Salt Lake City, Utah, United States

OBJECTIVES. Social determinants of health, particularly, social support mechanisms, are becomingly increasing identified as modifiable risk factors for health care utilization. We sought to determine the relationship between patientís social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. METHODS. We performed a retrospective cohort study of 60,895 patients undergoing complex cardiovascular procedures (valve replacement, coronary bypass grafting, lower extremity bypass, aortic aneurysm repair) or oncologic procedures (esophagectomy, gastrectomy, pancreatectomy, colectomy, cystectomy, nephrectomy) between 2001-2015. We linked patient demographic, residential, and genealogic information from the Utah Population Database with statewide healthcare encounters. Healthcare utilization outcomes were defined as 30-day all-cause readmission, 30-day CMS unplanned-readmission, 30-day non-index hospital readmission, index hospital length of stay, and home discharge disposition. For each patient, we aggregated the number of first-degree relatives (FDR) including spouses, parents and children older than 18 years living within 30 miles of the patientís home address at the time of the surgical procedure into following categories: 0-1, 2-3, 4-5, 6+ FDRs. We developed hierarchical generalized linear models to determine the relationship between of the number of FDR living within 30 miles of the patients address and the healthcare utilization outcomes after controlling for patient and hospital-level characteristics. RESULTS. Overall, the number of FDR living within 30 miles of the patients at the time of surgery was 0-1 for 13850 (23%) of patients, 2-3 for 14281 (23%) of patients, 4-5 for 13936 (23%) of patients and 6+ for 18828 (31%) of patients. Compared to patients with 0-1 FDRs, patients with 6+ FDRs had significantly lower rates of all-cause readmission (12.1% vs 13.5%, p<0.001), unplanned readmission (10.9% vs. 12.0%, p=0.001), non-index readmission (2.6% vs 3.2%, p=0.003); higher rates of home discharge (88.0% vs 85.3%, p<0.001) and shorter length of stay (7.3 days vs 7.8 days, p=0.02). After multivariable adjustment, a larger number of first-degree relatives living within 30 miles of the patientís home address at the time of surgery was significantly associated with a lower likelihood of all-cause readmission (p<0.001 for trend), 30-day unplanned readmission (p<0.001), non-index readmission (p<0.001); higher likelihood of home discharge (p<0.001); and shorter index length of stay (p<0.001). (Figure) CONCLUSIONS. The geographic proximity of family members is significantly associated with decreased healthcare utilization after complex cardiovascular and oncologic surgical procedures. These data provide strong evidence that social support mechanisms drive postoperative healthcare utilization and should be included in the perioperative risk assessment for patients.


Figure. Forrest plot of multivariable odds ratios (all-cause readmission, unplanned readmission, non-index readmission, home discharge) and incident rate ratio (length of stay) with 95% confidence intervals for the association with the number of first degree relatives (FDR) within 30 miles of a patients address at the time of the surgical procedure. A ratio whose 95% confidence interval which excludes 1 (dashed line) indicates statistical significance (p<0.05) compared to the reference group (0~1 FDR).


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