G. Porter1, S. Sakowitz1, K. Ali1, T. Coaston1, S. Mallick1, S.S. Ali1, H. Lee3, P. Benharash1,2 1University Of California – Los Angeles, Center For Advanced Surgical And Interventional Technology, Los Angeles, CA, USA 2University Of California – Los Angeles, Department Of Surgery, Los Angeles, CA, USA 3Harbor-UCLA Medical Center, Division Of Colon And Rectal Surgery, Department Of Surgery, Torrance, CA, USA
Introduction:
There is increasing recognition of the impact of social determinants of health (SDOH) on surgical outcomes. While racial and insurance-based disparities in the care and outcomes following colectomy have been previously documented, the impact of broader SDOH factors is underexplored.
Methods:
The 2016-2021 National Readmissions Database was queried for all adult (≥18 years) hospitalizations entailing elective or emergent colectomy ≤2 days of admission. We ascertained the presence of social vulnerability using validated diagnosis codes encompassing economic, education, social, healthcare, and environment-related needs. Patients with at least one SDOH risk factor were grouped as Vulnerable (others: Non-Vulnerable). Multivariable regression models were used to evaluate the association between SDOH and acute clinical and financial endpoints.
Results:
Of 1,332,443 patients, 154,631 (11.6%) were considered Vulnerable. On average, Vulnerable patients were older (67 [56-76 vs 63 [52-72] years, p<0.001), faced a greater comorbidity burden (4 [2-5] vs 2 [1-4], p<0.001), and more often underwent emergent colectomy (52.8 vs 28.4%, p<0.001), relative to Non-Vulnerable. Further, the Vulnerable cohort less often underwent minimally invasive colectomy (22.6 vs 41.4%, p<0.001) for colorectal cancer (38.8 vs 40.2%, p<0.001) or diverticulitis (24.5 vs 44.3%, p<0.001).
Among those receiving elective colectomy, and following risk-adjustment, vulnerability was linked with greater odds of in-hospital mortality (AOR 3.10, 95%CI 2.74-3.51;
Reference: Non-Vulnerable; Figure 1). Additionally, Vulnerable demonstrated greater likelihood of respiratory (AOR 2.84, 95%CI 2.66-3.04) and infectious complications (AOR 4.68, 95%CI 4.39-4.97). Evaluating resource utilization, vulnerability was associated with greater length of stay (LOS) (β+3.55 days, 95%CI 3.42-3.69), costs (β+$10,936, 95%CI 10,397-$11,476), and readmission (AOR 1.21, 95%CI 1.15-1.26).
Considering patients requiring emergent colectomy, vulnerability remained associated with greater likelihood of in-hospital mortality (AOR 1.53, 95%CI 1.42-1.64; Figure 1), as well as major complication (AOR 1.87, 95%CI 1.80-1.94). Moreover, Vulnerable demonstrated greater LOS (β+4.99 days, 95%CI 4.82-5.17), expenditures (β+ $17,115, 95%CI 16,402-$17,829), and readmission (AOR 1.05 95%CI 1.00-1.10).
Conclusion:
Social vulnerability is associated with higher morbidity and resource use after elective and emergent colectomy, with greater disparities in elective cases. Preoperative workups requiring significant health literacy and resources may contribute to these disparities, highlighting the need for structural interventions to improve care for vulnerable patients.