V. Clair1, D. Garofalo1,2, V. McCarthy1,2, C. Velopulos1,2, Q. Myers1,2 1University of Colorado, Department Of Surgery, Aurora, CO, USA 2Firearm Injury Prevention Initiative, Aurora, CO, USA
Introduction:
The Centers for Disease Control's (CDC) Social Vulnerability Index (SVI) is a neighborhood-based metric measuring social disparity and has been linked to variations in surgical outcomes. Recently, the Department of Transportation (DoT) introduced a similar score named the Social Vulnerability Score (SVS). This study aims to explore the relationship between the CDC’s SVI and DoT’s SVS for emergency versus elective surgeries. We hypothesize that higher levels of social vulnerability, regardless of metric, will correlate with increased rates of emergency surgeries, as well as higher morbidity, mortality, and readmission rates.
Methods:
This was a retrospective cohort study utilizing ACS NSQIP data from a single academic institution for the years 2012-2017. We included emergent general surgery that could have been performed electively, such as cholecystectomies and hernias, using CPT codes. Patients were categorized into high and low-vulnerability groups based on their SVI and SVS. High SVI was considered ≥75%ile and high SVS was considered ≥60%ile based on DoT instructions. Bivariate analysis compared rates of emergency surgery, morbidity, mortality, unplanned readmission, and nonhome discharge between high and low-vulnerability groups. Multiple logistic regression models were used to compare the performance of both scores in predicting emergency surgery versus elective surgery and postoperative morbidity.
Results:
A total of 5,219 patients were included in the study, with 22.4% in the high CDC SVI cohort and 21.9% in the high DoT SVS cohort. In bivariate analysis, high SVI and SVS were associated with increased emergency surgery (16.6% vs. 13.8%, p=0.023; 16.9% vs. 13.7%, p=0.008), morbidity (15.4% vs. 12.4%, p=0.010; 15.8% vs. 12.3%, p=0.003), and unplanned readmission (4.8% vs. 3.9%, p=0.0145.2% vs. 3.9%, p=0.014). High SVS was also associated with nonhome discharge (8.9% vs. 6.5%, p=0.007). Multiple logistic regression showed that both high SVI (OR=1.35 [1.10, 1.66], p<0.01) and high SVS (OR=1.37 [1.17, 1.68], p<0.01) were independent risk factors for emergency surgery, but neither significantly impacted risk-adjusted morbidity.
Conclusion:
High vulnerability as measured by both CDC SVI and DoT SVS is independently associated with increased rates of emergency surgery and unplanned readmission but does not significantly impact risk-adjusted morbidity. Despite the scores being calculated differently, measures of social vulnerability are still related to worse outcomes and can help focus attention on patients that may need additional resources. These findings highlight the importance of addressing social determinants of health (SDOH) to mitigate disparities in surgical outcomes and improve patient care.