Skip to main content
SpringerLink
Log in

Association of ICD-10 Clinical Modification Codes for Social Determinants of Health with Surgical Outcomes and Hospital Charges Among Cancer Patients

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

We sought to characterize the impact of social determinants of health (SDOH)-related codes on outcomes among patients with a cancer diagnosis.

Methods

Patients diagnosed with lung, pancreas, colon, or rectal cancer between 2017 and 2020 were identified in the California Department of Healthcare Access and Information Patient Discharge Database. Data on concomitant SDOH-related codes (International Classification of Diseases, Tenth Revision [ICD-10] Z55–Z65) designating health hazards related to socioeconomic and psychosocial circumstances were obtained. The association of these SDOH codes with postoperative outcomes was evaluated.

Results

Among 10,421 patients who underwent an operation from 2017 to 2020, median age was 66 years (interquartile range [IQR] 56–75) and nearly half of the cohort was male (n = 551,252.9%). In total, 102 (1%) patients had a concurrent ICD-10 SDOH diagnosis. After controlling for competing risk factors, the risk-adjusted probability of in-hospital death was 4.1% (95% confidence interval [CI] 1.0–7.2) among patients with an SDOH diagnosis compared with 2.9% (95% CI 2.5–3.2) among patients without an SDOH diagnosis (odds ratio [OR] 1.52, 95% CI 0.63–3.66; p = 0.258); postoperative complications were 27.0% (95% CI 20.0–34.1) compared with 24.9% (95% CI 24.1–25.6) among patients without an SDOH diagnosis (OR 1.15, 95% CI 0.73–1.82; p = 0.141), and length of stay was 10.6 days (95% CI 10.0–11.2) compared with 9.4 days (95% CI 9.3–9.5) among patients without an SDOH diagnosis. Patients with an SDOH diagnosis had a 5.19 (95% CI 3.23–8.34; p < 0.005) higher odds of being discharged to a skilled nursing facility versus patients without an SDOH diagnosis.

Conclusion

Uptake and utilization of ICD-10 SDOH was 1% among California patients with lung, pancreas, colon, or rectal cancer. Patients with a concomitant ICD-10 SDOH code had longer length of stay and had higher odds of being discharged to a skilled nursing facility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. McNelis J, Castaldi M. “The national surgery quality improvement project” (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit. Patient Saf Surg. 2014;8(1):1–5. https://doi.org/10.1186/1754-9493-8-19.

    Article  Google Scholar 

  2. Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504. https://doi.org/10.1001/jama.2015.25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY. Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg. 2009;144(11):1013–20. https://doi.org/10.1001/archsurg.2009.114.

    Article  PubMed  Google Scholar 

  4. Schneider EB, Haider A, Sheer AJ, et al. Differential association of race with treatment and outcomes in medicare patients undergoing diverticulitis surgery. Arch Surg. 2011;146(11):1272–6. https://doi.org/10.1001/archsurg.2011.280.

    Article  PubMed  Google Scholar 

  5. Wood MH, Carlin AM, Ghaferi AA, et al. Association of race with bariatric surgery outcomes. JAMA Surg. 2019;154(5):e190029–e190029. https://doi.org/10.1001/jamasurg.2019.0029.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zogg CK, Scott JW, Jiang W, Wolf LL, Haider AH. Differential access to care: the role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates. Surgery. 2016;160(5):1145–54. https://doi.org/10.1016/j.surg.2016.06.002.

    Article  PubMed  Google Scholar 

  7. De Oliveira GS, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg. 2015;15(1):86. https://doi.org/10.1186/s12893-015-0073-6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nyman MH, Nilsson U, Dahlberg K, Jaensson M. Association between functional health literacy and postoperative recovery, health care contacts, and health-related quality of life among patients undergoing day surgery: secondary analysis of a randomized clinical trial. JAMA Surg. 2018;153(8):738–45. https://doi.org/10.1001/jamasurg.2018.0672.

    Article  Google Scholar 

  9. Wright JP, Moses K, Idrees K. Making the case for importance of health literacy in the surgical population. JAMA Surg. 2018;153(8):745–6. https://doi.org/10.1001/jamasurg.2018.0673.

    Article  PubMed  Google Scholar 

  10. Golz RA, Flum DR, Sanchez SE, Liu X, Donovan C, Drake FT. Geographic association between incidence of acute appendicitis and socioeconomic Status. JAMA Surg. 2020;155(4):330–8. https://doi.org/10.1001/jamasurg.2019.6030.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diaz A, Schoenbrunner A, Pawlik TM. Trends in the geospatial distribution of inpatient adult surgical services across the United States. Ann Surg. 2021;273(1):121–7. https://doi.org/10.1097/SLA.0000000000003366.

    Article  PubMed  Google Scholar 

  12. Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible—the neighborhood atlas. N Engl J Med. 2018;378(26):2456–8. https://doi.org/10.1056/NEJMp1802313.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arcaya M, Tucker-Seeley R, Kim R, Schnake-Mahl A, So M, Subramanian S. Research on neighborhood effects on health in the united states: a systematic review of study characteristics. Soc Sci Med. 2016;168:16–29. https://doi.org/10.1016/j.socscimed.2016.08.047.

    Article  PubMed  PubMed Central  Google Scholar 

  14. CDC’s Social Vulnerability Index. 2018. https://svi.cdc.gov/. Accessed 14 Mar 2020.

  15. Diaz A, Hyer JM, Barmash E, Azap R, Paredes AZ, Pawlik TM. County-level social vulnerability is associated with worse surgical outcomes especially among minority patients. Ann Surg. 2021;274(6):881–91. https://doi.org/10.1097/SLA.0000000000004691.

    Article  PubMed  Google Scholar 

  16. Hyer JM, Tsilimigras DI, Diaz A, et al. High social vulnerability and “textbook outcomes” after cancer operation. J Am Coll Surg. 2021;232(4):351–9.

    Article  PubMed  Google Scholar 

  17. Diaz A, Lindau ST, Obeng-Gyasi S, Dimick JB, Scott JW, Ibrahim AM. Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among medicare beneficiaries. JAMA Netw Open. 2023;6(1):e2253620. https://doi.org/10.1001/jamanetworkopen.2022.53620.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kolak M, Bhatt J, Park YH, Padrón NA, Molefe A. Quantification of neighborhood-level social determinants of health in the continental United States. JAMA Netw Open. 2020;3(1):e1919928. https://doi.org/10.1001/jamanetworkopen.2019.19928.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Centers for Medicare and Medicaid Services. ICD-10-CM Official Guidelines for Coding and Reporting. https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf. Accessed 3 Apr 2023.

  20. Hatef E, Rouhizadeh M, Tia I, et al. Assessing the availability of data on social and behavioral determinants in structured and unstructured electronic health records: a retrospective analysis of a multilevel health care system. JMIR Med Inform. 2019;7(3):e13802. https://doi.org/10.2196/13802.

    Article  PubMed  PubMed Central  Google Scholar 

  21. De Marchis EH, Ettinger de Cuba SA, Chang L, et al. Screening Discordance and characteristics of patients with housing-related social risks. Am J Prev Med. 2021;61(1):e1–12. https://doi.org/10.1016/j.amepre.2021.01.027.

    Article  PubMed  Google Scholar 

  22. HUD USPS ZIP Code Crosswalk Files | HUD USER. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Accessed 1 Apr 2023.

  23. Adler NE, Glymour MM, Fielding J. Addressing Social determinants of health and health inequalities. JAMA. 2016;316(16):1641–2. https://doi.org/10.1001/jama.2016.14058.

    Article  PubMed  Google Scholar 

  24. Artiga S, Hinton E. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. KFF. 2018. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. Accessed 24 Jun 2020.

  25. Truong HP, Luke AA, Hammond G, Wadhera RK, Reidhead M, Joynt Maddox KE. Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016–2017. Med Care. 2020;58(12):1037. https://doi.org/10.1097/MLR.0000000000001418.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sullivan GA, Gely Y, Donaldson A, Rangel M, Gulack BC, Shah AN. Use of international classification of diseases, tenth revision, clinical modification Z codes to identify social determinants of health among surgical patients. JAMA Surg. 2022;157(8):735–7. https://doi.org/10.1001/jamasurg.2022.1211.

    Article  PubMed  PubMed Central  Google Scholar 

  27. R3 Report Issue 36: New Requirements to Reduce Health Care Disparities | The Joint Commission. https://www.jointcommission.org/standards/r3-report/r3-report-issue-36-new-requirements-to-reduce-health-care-disparities/#.ZDVV2uzMI-R. Accessed 11 Apr 2023.

  28. Meaningful Measures 2.0: Moving from Measure Reduction to Modernization | CMS. https://www.cms.gov/medicare/meaningful-measures-framework/meaningful-measures-20-moving-measure-reduction-modernization. Accessed 11 Apr 2023.

  29. Hyer JM, Tsilimigras DI, Diaz A, et al. High social vulnerability and “textbook outcomes” after cancer operation. J Am Coll Surg. 2021;232(4):351–9. https://doi.org/10.1016/j.jamcollsurg.2020.11.024.

    Article  PubMed  Google Scholar 

  30. Zhang Y, Kunnath N, Dimick JB, Scott JW, Diaz A, Ibrahim AM. Social vulnerability and outcomes for access-sensitive surgical conditions among medicare beneficiaries. Health Aff (Millwood). 2022;41(5):671–9. https://doi.org/10.1377/hlthaff.2021.01615.

    Article  PubMed  Google Scholar 

  31. Diaz A, Barmash E, Azap R, Paredes AZ, Hyer JM, Pawlik TM. Association of county-level social vulnerability with elective versus non-elective colorectal surgery. J Gastrointest Surg. 2021;25(3):786–94. https://doi.org/10.1007/s11605-020-04768-3.

    Article  PubMed  Google Scholar 

  32. Diaz A, Beane JD, Hyer JM, Tsilimigras D, Pawlik TM. Impact of hospital quality on surgical outcomes in patients with high social vulnerability: association of textbook outcomes and social vulnerability by hospital quality. Surgery. 2022;171(6):1612–8. https://doi.org/10.1016/j.surg.2021.10.021.

    Article  PubMed  Google Scholar 

Download references

Funding

No sources of funding were used to assist in the preparation of this article.

Author information

Authors and Affiliations

  1. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Adrian Diaz MD, MPH & Timothy Pawlik MD, PhD, MPH, MTS, MBA

Authors
  1. Adrian Diaz MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy Pawlik MD, PhD, MPH, MTS, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian Diaz MD, MPH.

Ethics declarations

Disclosure

Adrian Diaz and Timothy Pawlik have no disclosures to declare in relation to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Diaz, A., Pawlik, T. Association of ICD-10 Clinical Modification Codes for Social Determinants of Health with Surgical Outcomes and Hospital Charges Among Cancer Patients. Ann Surg Oncol 31, 1171–1177 (2024). https://doi.org/10.1245/s10434-023-14501-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-14501-4

Search

Navigation