Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies

Yize I Wan; Dermot McGuckin; Alexander J Fowler; John R Prowle; Rupert M Pearse; S Ramani Moonesinghe

doi:10.1016/j.bja.2020.10.019

Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies

Br J Anaesth. 2021 Mar;126(3):642-651. doi: 10.1016/j.bja.2020.10.019. Epub 2020 Nov 18.

Authors

Yize I Wan¹, Dermot McGuckin², Alexander J Fowler³, John R Prowle³, Rupert M Pearse³, S Ramani Moonesinghe⁴

Affiliations

¹ William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK. Electronic address: yize.wan@qmul.ac.uk.
² Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK.
³ William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK.
⁴ Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK.

PMID: 33220938
DOI: 10.1016/j.bja.2020.10.019

Abstract

Background: Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS).

Methods: We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals.

Results: Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17-1.78]; P<0.001), IMD2 (OR=1.38 [1.12-1.70]; P<0.01), IMD3 (OR=1.09 [0.88-1.35]: P=0.44), IMD4 (OR=0.89 [0.71-1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23-1.67]; P<0.0001), IMD2 (HR=1.35 [1.15-1.57]; P<0.001), IMD3 (HR=1.04 [0.89-1.23]; P=0.60), and IMD4 (HR=1.11 [0.95-1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival.

Conclusions: Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.

Keywords: healthcare disparities; mortality; postoperative complications; socioeconomic factors; surgery; survival.

Publication types

Observational Study

MeSH terms

Delivery of Health Care / standards*
Elective Surgical Procedures*
Humans
Postoperative Complications / mortality*
Proportional Hazards Models
Prospective Studies
Socioeconomic Factors*
Survival Analysis