Journal Article

Association of mortality and social deprivation index in patients undergoing emergency general surgery: Results from a regional healthcare system

May, Addison, Lewis, Hailey, Lauer, Cynthia, Jacobs, David, Brake, Julia, Wang, Huaping, Thompson, Kyle, Reinke, Caroline, Ross, Samuel

2025

Overview

Emergency General Surgery (EGS) has high complication and mortality rates and social factors have been associated with outcomes in national datasets. Social deprivation index (SDI) is a validated geographic area demographic index used to quantify variations in healthcare. We sought to examine the association of SDI with mortality of high-risk EGS procedures at a regional level across a large integrated healthcare system. This is a retrospective cohort study of adult patients with ICD10 codes for EGS diagnoses who underwent high-risk procedures (small bowel resection, colectomy, gastroduodenal repair or resection, or combined procedures) in a large integrated healthcare system from 2017 to 2021. Our primary exposure was SDI. Primary outcome was inpatient mortality. Secondary outcomes were return to OR (RTOR), venous thromboembolism (VTE), and extended length of stay (≥75th percentile by procedure) (ELOS). Outcomes were analyzed by SDI and adjusted for age, race, Elixhauser Comorbidity Index, insurance, procedure, and initial shock index using multivariable logistic regression. Facilities were also analyzed by the SDI distribution of their EGS population. A total of 9441 hospital encounters were identified with 2765 high-risk procedure hospital encounters across nine hospitals. Overall inpatient mortality in the study cohort was 8.6 ​%. EGS patients undergoing high-risk procedures from the most disadvantaged areas had higher mortality rates and were more likely to require RTOR than those from the least disadvantaged areas after adjustment for covariates (OR 2.1, p ​= ​0.01; OR 1.9, p ​= ​0.001). SDI is associated with higher mortality and RTOR in EGS patients undergoing high-risk procedures. This study highlights the importance of local or regional area descriptions of population deprivation which may lead to geographically targeted interventions and prevention strategies. •Emergency general surgery patients from disadvantaged areas had higher mortality rates than patients from less disadvantaged areas•Emergency general surgery patients from disadvantaged areas were more likely to require return to the OR than patients from less disadvantage areas•Facilities within a large healthcare system had different proportions of patients from disadvantaged areas•Geographic targeting of interventions to communities at risk may improve surgical outcomes

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Care Surgery / Adult / Age / Aged / Codes / Colorectal surgery / Comorbidity / Deprivation / Disease / Emergencies / Emergency general surgery / Female / Health care / Hospital Mortality / Hospitals / Households / Humans / Length of stay / Length of Stay - statistics & numerical data / Male / Middle Aged / Mortality / Patients / Postoperative Complications - epidemiology / Retrospective Studies / Risk / Small intestine / Social Deprivation / Social deprivation index / Social determinant of health / Social factors / Socioeconomic factors / Socioeconomic status / Surgery / Surgical Procedures, Operative - mortality / Thromboembolism / Variables