F. Rahim1, E. De Jager1, M. A. Chaudhary1, J. M. Havens3,4, E. Goralnick1,2, A. Haider1,4 1Center for Surgery and Public Health,Boston, MA, USA 2Brigham And Women’s Hospital,Emergency Preparedness And Access Center,Boston, MA, USA 3Harvard School Of Medicine,Brookline, MA, USA 4Brigham And Women’s Hospital,Surgery,Boston, MA, USA
Introduction:
Emergency General Surgery (EGS) conditions account for more than 2 million US hospital admissions annually. EGS patients in the highest income quartile have lower odds of mortality compared to the lowest income quartile, which may be related to a disparity in access to high quality centres. Rural areas have fewer providers and subsequently less provider choice compared with urban areas. Our objective was to examine if the high income EGS survival benefit holds true in rural areas.
Methods:
The National Inpatient Sample (2007-2014) was queried for patients aged 18-64, with a primary diagnosis of the American Association for Surgery of Trauma’s 10 most common EGS procedures. The effect of patient income quartiles on surgical adverse events (total complications and mortality) was assessed using multivariable regression models in urban and rural cohorts adjusting for age, race/ethnicity, sex, Charlson Comorbidity Index, insurance status, hospital region and teaching status.
Results:
1,687,828 patients underwent one of the EGS procedures performed during the study period. 16.59% (n=280,036) of patients were rural. The overall distribution of income quartiles was 21.35% (n=351,500) highest, 24.37% (n=401,292) high middle, 25.78% (n=424,409) low middle and 28.50% (n=469,152) lowest. Compared to urban settings, rural settings had higher mortality (1.16 vs 1.23% p<0.001) and complication rates (15.46 vs 16.54%, p<0.001) in our univariate analysis. In the urban cohort multivariate analysis, lower income quartiles were associated with higher odds of in hospital mortality and total complications relative to the high-income quartile. In the rural cohort, income quartiles were not associated with the odds of adverse events (Table).
Conclusion:
Patients in the highest income had a survival benefit and lower risk of postoperative complications in urban but not in rural settings. The disparity in EGS outcomes between higher and lower socioeconomic status in urban settings, but not in rural settings, could be related to limited provider choice in rural areas.
