TY - JOUR T1 - Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 232 LP - 237 DO - 10.1136/bmjqs-2019-009800 VL - 29 IS - 3 AU - J Hunter Mehaffey AU - Robert B Hawkins AU - Eric J Charles AU - Florence E Turrentine AU - Brian Kaplan AU - Sandy Fogel AU - Charles Harris AU - David Reines AU - Jorge Posadas AU - Gorav Ailawadi AU - John B Hanks AU - Peter T Hallowell AU - R Scott Jones Y1 - 2020/03/01 UR - http://qualitysafety.bmj.com/content/29/3/232.abstract N2 - Background Socioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.Methods All patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.Results A total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted riskConclusion Increasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives. ER -