A Surgical Desirability of Outcome Ranking (DOOR) Reveals Complex Relationships Between Race/Ethnicity, Insurance Type, and Neighborhood Deprivation

被引：2

作者：

Jacobs, Michael A. ^{[1
]}

Schmidt, Susanne ^{[2
]}

Hall, Daniel E. ^{[3
,4
,5
,6
]}

Stitzenberg, Karyn B. ^{[7
]}

Kao, Lillian S. ^{[8
]}

Brimhall, Bradley B. ^{[9
,10
]}

Wang, Chen-Pin ^{[2
]}

Manuel, Laura S. ^{[11
]}

Su, Hoah-Der ^{[12
]}

Silverstein, Jonathan C. ^{[12
]}

Shireman, Paula K. ^{[1
,13
,14
]}

机构：

[1] Univ Texas Hlth San Antonio, Dept Surg, San Antonio, TX 78229 USA

[2] Univ Texas Hlth San Antonio, Dept Populat Hlth Sci, San Antonio, TX USA

[3] Vet Affairs Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Pittsburgh, PA USA

[4] Vet Affairs Pittsburgh Healthcare Syst, Geriatr Res Educ & Clin Ctr, Pittsburgh, PA USA

[5] Univ Pittsburgh, Dept Surg, Pittsburgh, PA USA

[6] UPMC, Wolff Ctr, Pittsburgh, PA USA

[7] Univ N Carolina, Dept Surg, Chapel Hill, NC USA

[8] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Dept Surg, Houston, TX USA

[9] Univ Texas Hlth San Antonio, Dept Pathol & Lab Med, San Antonio, TX USA

[10] Univ Hlth, San Antonio, TX USA

[11] Univ Texas Hlth San Antonio, UT Hlth Phys Business Intelligence & Data Analyt, San Antonio, TX, Chile

[12] Univ Pittsburgh, Dept Biomed Informat, Pittsburgh, PA USA

[13] Texas A&M Hlth, Sch Med, Dept Primary Care & Rural Med, Bryan, TX 77807 USA

[14] Texas A&M Hlth, Sch Med, Dept Med Physiol, Bryan, TX 77807 USA

来源：

ANNALS OF SURGERY | 2024年 / 279卷 / 02期

关键词：

health disparities; social determinants of health; surgical outcomes; COMPOSITE END-POINTS; RISK ANALYSIS INDEX; SOCIAL DETERMINANTS; RACIAL-DIFFERENCES; CLINICAL REGISTRY; CLAIMS DATA; SAFETY-NET; MORTALITY; HEALTH; RACE;

D O I：

10.1097/SLA.0000000000005994

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health.Background: Studies focused on single or binary composite outcomes may not detect health disparities.Methods: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO).Results: Patients living in highly deprived neighborhoods (ADI>85) had higher odds of PASC [adjusted odds ratio (aOR)=1.13, CI=1.02-1.25, P<0.001] and urgent/emergent cases (aOR=1.23, CI=1.16-1.31, P<0.001). Increased odds of higher/less desirable DOOR scores were associated with patients identifying as Black versus White and on Medicare, Medicaid or Uninsured versus Private insurance. Patients with ADI>85 had lower odds of TO (aOR=0.91, CI=0.85-0.97, P=0.006) until adjusting for insurance. In contrast, patients with ADI>85 had increased odds of higher DOOR (aOR=1.07, CI=1.01-1.14, P<0.021) after adjusting for insurance but similar odds after adjusting for PASC and urgent/emergent cases.Conclusions: DOOR revealed complex interactions between race/ethnicity, insurance type and neighborhood deprivation. ADI>85 was associated with higher odds of worse DOOR outcomes while TO failed to capture the effect of ADI. Our results suggest that presentation acuity is a critical determinant of worse outcomes in patients in highly deprived neighborhoods and without insurance. Including risk adjustment for living in deprived neighborhoods and urgent/emergent surgeries could improve the accuracy of quality metrics.

引用

页码：246 / 257

页数：12