Social Vulnerability and Emergency General Surgery among Medicare Beneficiaries

Abstract

INTRODUCTION: Although the Social Vulnerability Index (SVI) was created to identify vulnerable populations after natural disasters, its ability to identify similar groups of patients after emergency general surgery is unknown. We aimed to examine the association between SVI and outcomes after emergency general surgery. METHODS: Cross-sectional review of 887,193 Medicare beneficiaries who underwent 1 of 4 common emergency general surgery procedures (appendectomy, cholecystectomy, colectomy, and ventral hernia repair) performed in the urgent or emergent setting between 2014 and 2018. These data were merged with the SVI at the census track level of residence. Risk-adjusted outcomes (30-day mortality, serious complication, readmission) were evaluated using a logistic regression model accounting for age, sex, comorbidity, year, procedure type, and hospital characteristics between high and low social vulnerability quintiles and within the 4 SVI subthemes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation). RESULTS: Compared with beneficiaries with low social vulnerability, Medicare beneficiaries living in areas of high social vulnerability experienced higher rate of 30-day mortality (8.6% vs 8.1%; adjusted odds ratio [OR] 1.07; p < 0.001), serious complication (20.7% vs 18.4%; OR 1.17; p < 0.001), and readmission (16.1% vs 15.0%; OR 1.08; p < 0.001). This pattern of differential outcomes was present in subgroup analysis of all 4 SVI subthemes but was greatest in the housing/transportation subtheme. CONCLUSION: National efforts to support patients with high social vulnerability from natural disasters may be well aligned with efforts to identify communities that are particularly vulnerable to worse postoperative outcomes after emergency general surgery. Policies targeting housing/transportation may help alleviate these disparities.