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Association of County-Level Social Vulnerability with Elective Versus Non-elective Colorectal Surgery

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

A person’s community, or lived environment, may play an important role in achieving optimal health outcomes. The objective of the current study was to assess the association of county-level vulnerability with the probability of having a non-elective colon resection. We hypothesized that individuals from areas with a high social vulnerability would be at greater risk of non-elective colon resection compared with patients from low social vulnerability areas.

Methods

Patients aged 65–99 who underwent a colon resection for a primary diagnosis of either diverticulitis (n = 11,812) or colon cancer (n = 33,312) were identified in Medicare Part A and Part B for years 2016–2017. Logistic regression analysis was used to evaluate differences in probability of undergoing an elective versus non-elective operation from counties relative to county-level social vulnerability index (SVI). Secondary outcomes included postoperative complications, mortality, readmission, and index hospitalization expenditure.

Results

Among 45,124 patients, 11,812 (26.2%) underwent a colon resection for diverticulitis, while 33,312 (73.8%) had a resection for colon cancer; 31,012 (68.7%) patients had an elective procedure (diverticulitis n = 7291 (61.7%) vs. cancer n = 23,721 (71.2%)), while 14,112 (31.3%) had an emergent operation (diverticulitis n = 4521 (38.3%) vs. cancer n = 9591 (28.8%)). Patients with a high SVI were more likely to undergo an emergent colon operation compared with low SVI patients (43.7% vs. 40.4%) (p < 0.001). The association of high SVI with increased risk of an emergent colon operation was similar among patients with diverticulitis (emergent: low SVI 37.2% vs. high SVI 40.4%) or colon cancer (emergent: low SVI 26.0% vs. high SVI 29.9%) (both p < 0.05). On multivariable analyses, risk-adjusted probability of undergoing an urgent/emergent operation remained associated with SVI (p < 0.05).

Conclusion

Patients residing in vulnerable communities characterized by a high SVI were more likely to undergo a non-elective colon resection for either diverticulitis or colon cancer. Patients from high SVI areas had a higher risk of postoperative complications, as well as index hospitalization expenditures; however, there were no differences in mortality or readmission rates.

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Funding

Dr. Diaz receives funding from the University of Michigan Institute for Healthcare Policy and Innovation Clinician Scholars Program and salary support from the Veterans Affairs Office of Academic Affiliations during the time of this study

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Adrian Diaz, Rosevine Azap, Anghela Z. Paredes, J. Madison Hyer & Timothy M. Pawlik

  2. National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Adrian Diaz

  3. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Adrian Diaz

  4. Ohio State University College of Medicine, Columbus, OH, USA

    Elizabeth Barmash

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  1. Adrian Diaz
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Appendix

Appendix

Table 5 Risk-adjusted outcomes for elective and non-elective surgery stratified by indication for colon resection
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Diaz, A., Barmash, E., Azap, R. et al. Association of County-Level Social Vulnerability with Elective Versus Non-elective Colorectal Surgery. J Gastrointest Surg 25, 786–794 (2021). https://doi.org/10.1007/s11605-020-04768-3

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