Socioeconomic disadvantage and pediatric surgical outcomes

Introduction: The impact of socioeconomic status on surgical outcomes has not been well-studied in children. Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage. Methods: A retrospective analysis of surgical patients ages 0-21 years was performed at a quaternary pediatric hospital from 1/1/2016-12/31/2020. Logistic regression was used to assess the relationship between ADI, 30-day postoperative mortality and serious adverse events (SAE). Results: Among 56,655 patients, the incidence of 30-day mortality and SAE were 0.3% and 8.9%. On univariable regression, patients from higher state ADI neighborhoods had increased odds of 30-day postoperative mortality and SAE. After controlling for covariates, patients from a neighborhood with state ADI ranks of 9 and 10 had 24% (95% CI: 1.06-1.45) and 27% (95% CI: 1.08-1.49) increased odds of experiencing SAE. Discussion: Pediatric surgical patients from disadvantaged neighborhoods may experience worse postoperative outcomes irrespective of patient demographics and preoperative health status.