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The following is a summary of “Association of socioeconomic vulnerability with outcomes after emergency general surgery,” published in the May 2024 issue of Surgery by Sakowitz et al.

The influence of socioeconomic vulnerability on outcomes following emergency general surgery still needs to be more adequately explored despite its recognized impact on health outcomes. This study aimed to investigate these associations using data from the 2016 to 2020 Nationwide Readmissions Database.

Researchers analyzed adult hospitalizations (≥18 years) for emergency general surgery procedures within two days of non-elective admission, including appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection. Socioeconomic vulnerability was defined using pertinent diagnosis codes encompassing economic, educational, healthcare, environmental, and social needs. Patients identified as vulnerable were compared against non-vulnerable counterparts. Multivariable models were employed to assess independent associations between socioeconomic vulnerability and key surgical outcomes.

Among approximately 1,788,942 patients, 177,764 (9.9%) were vulnerable. Vulnerable patients were significantly older (median age 67 vs. 58 years, P < .001), more likely insured by Medicaid (16.4% vs. 12.7%, P < .001), and exhibited higher Elixhauser Comorbidity Index scores (median 4 vs. 2, P < .001) compared to non-vulnerable patients. Adjusted for risk factors, the vulnerability was independently associated with higher odds of in-hospital mortality (adjusted odds ratio 1.64, 95% CI 1.58–1.70) and perioperative complications (adjusted odds ratio 2.02, 95% CI 1.98–2.06). Vulnerable patients also experienced prolonged hospital stays (β +4.64 days, 95% CI +4.54–4.74) and increased hospitalization costs (β +$1,360, 95% CI +$980–$1,740). Additionally, vulnerability correlated with elevated odds of non-home discharge (adjusted odds ratio 2.44, 95% CI 2.38–2.50) and non-elective readmission within 30 days post-discharge (adjusted odds ratio 1.29, 95% CI 1.26–1.32).

Socioeconomic vulnerability independently predicts higher morbidity, healthcare resource utilization, and readmission rates following emergency general surgery. These findings underscore the urgent need for innovative interventions in hospital screening and care pathways to mitigate disparities and enhance outcomes for vulnerable patients.

Source: sciencedirect.com/science/article/pii/S0039606024002095