Social vulnerability is associated with increased morbidity following colorectal surgery

Heather Carmichael; Adam R Dyas; Michael R Bronsert; Dorothy Stearns; Elisa H Birnbaum; Robert C McIntyre; Robert A Meguid; Catherine G Velopulos

doi:10.1016/j.amjsurg.2022.03.010

Social vulnerability is associated with increased morbidity following colorectal surgery

Am J Surg. 2022 Jul;224(1 Pt A):100-105. doi: 10.1016/j.amjsurg.2022.03.010. Epub 2022 Mar 9.

Authors

Heather Carmichael¹, Adam R Dyas², Michael R Bronsert³, Dorothy Stearns⁴, Elisa H Birnbaum⁵, Robert C McIntyre⁶, Robert A Meguid⁷, Catherine G Velopulos⁸

Affiliations

¹ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: heather.carmichael@cuanschutz.edu.
² Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: adam.dyas@cuanschutz.edu.
³ Surgical Outcomes and Applied Research, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: michael.bronsert@cuanschutz.edu.
⁴ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: dorothy.stearns@cuanschutz.edu.
⁵ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: elisa.birnbaum@cuanschutz.edu.
⁶ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: robert.mcintyre@cuanschutz.edu.
⁷ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA; Surgical Outcomes and Applied Research, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: robert.meguid@cuanschutz.edu.
⁸ Department of Surgery, University of Colorado, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA; Surgical Outcomes and Applied Research, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA. Electronic address: catherine.velopulos@cuanschutz.edu.

PMID: 35337645
DOI: 10.1016/j.amjsurg.2022.03.010

Abstract

Introduction: Neighborhood measures of social vulnerability encompassing multiple sociodemographic factors can be used to quantify disparities in outcomes. We hypothesize patients with high Social Vulnerability Index (SVI) are at increased risk of morbidity following colectomy.

Methods: We used local 2012-2017 National Surgical Quality Improvement Program (NSQIP) data to study colectomy patients, examining associations between SVI and postoperative outcomes.

Results: We included 976 patients from five hospitals. High SVI (>75th percentile) was associated with increased postoperative morbidity on unadjusted analysis (OR 1.84, 95% CI 1.35-2.52, p < 0.001); this association persisted after adjusting for demographics and comorbidities (OR 1.63, 95% CI 1.15-2.31, p = 0.005). The association with SVI was not significant after adjusting for perioperative risk modifiers such as emergent presentation (OR 1.37, 95% CI 0.95-1.98, p = 0.10).

Conclusions: High social vulnerability is associated with increased postoperative complications. This effect appears mediated by perioperative risk factors, suggesting potential to improve outcomes by facilitating timely surgical intervention.

Keywords: Access to care; Colectomy; Emergency general surgery; Geographic information systems; Healthcare disparities; Social vulnerability index.

MeSH terms

Colectomy / adverse effects
Colorectal Surgery*
Humans
Morbidity
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Social Vulnerability