Disparities in surgical outcomes for low socioeconomic status patients in Australia.
disparities
socioeconomic status
surgery
surgical outcomes
unemployed
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
16
03
2022
received:
10
02
2022
accepted:
20
03
2022
pubmed:
8
4
2022
medline:
12
5
2022
entrez:
7
4
2022
Statut:
ppublish
Résumé
There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self-reported unemployment and neighbourhood level socioeconomic status in Australia. A retrospective administrative data review was conducted at a tertiary care centre over a 10-year period (2008-2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed. 106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50-2.82), OR 1.37 (1.15-1.64)), all complications (OR 1.43 (1.31-1.56), OR 1.21 (1.14-1.28)), failure to rescue (OR 2.03 (1.39-2.95), OR 1.38 (1.11-1.72)) and return to theatre (OR 1.42 (1.27-1.59), OR 1.24 (1.14-1.36)) (P < 0.005 for all). Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.
Sections du résumé
BACKGROUND
There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self-reported unemployment and neighbourhood level socioeconomic status in Australia.
METHODS
A retrospective administrative data review was conducted at a tertiary care centre over a 10-year period (2008-2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed.
RESULTS
106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50-2.82), OR 1.37 (1.15-1.64)), all complications (OR 1.43 (1.31-1.56), OR 1.21 (1.14-1.28)), failure to rescue (OR 2.03 (1.39-2.95), OR 1.38 (1.11-1.72)) and return to theatre (OR 1.42 (1.27-1.59), OR 1.24 (1.14-1.36)) (P < 0.005 for all).
CONCLUSIONS
Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.
Identifiants
pubmed: 35388595
doi: 10.1111/ans.17675
pmc: PMC9322460
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1026-1032Subventions
Organisme : Avant Doctor in Training Research Scholarship
Informations de copyright
© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
J Epidemiol Community Health. 2009 Feb;63(2):92-8
pubmed: 18930981
Am J Public Health. 2012 May;102(5):979-87
pubmed: 22420787
Vasc Endovascular Surg. 2018 Jul;52(5):330-334
pubmed: 29554858
Ann Thorac Surg. 2021 Feb;111(2):561-567
pubmed: 32682753
Front Public Health. 2014 Jul 29;2:94
pubmed: 25121083
Heart Lung Circ. 2014 Mar;23(3):265-72
pubmed: 24321647
J Am Coll Surg. 2019 Mar;228(3):276-298
pubmed: 30803548
J Am Coll Surg. 2015 Jun;220(6):1077-1086.e3
pubmed: 25998083
Heart. 2003 Sep;89(9):1062-6
pubmed: 12923028
World J Surg. 2018 Jul;42(7):1971-1980
pubmed: 29270649
J Card Surg. 2021 Jun;36(6):2035-2043
pubmed: 33682934
Med Care. 2015 Jan;53(1):18-24
pubmed: 25373403
PLoS One. 2018 Jan 22;13(1):e0191464
pubmed: 29357383
J Epidemiol Community Health. 2000 Dec;54(12):930-5
pubmed: 11076990
Ann Surg. 2010 Sep;252(3):552-7; discussion 557-8
pubmed: 20739856
BMJ Qual Saf. 2020 Mar;29(3):232-237
pubmed: 31540969
Med Care. 2008 Sep;46(9):893-9
pubmed: 18725842
J Surg Res. 2020 Jan;245:629-635
pubmed: 31522036
BMC Cardiovasc Disord. 2018 May 16;18(1):94
pubmed: 29769031
Int J Cardiol. 2007 Nov 15;122(2):168-9
pubmed: 17234282
JAMA Netw Open. 2019 Oct 2;2(10):e1912339
pubmed: 31577353
Int J Surg. 2014;12(9):906-11
pubmed: 25084098
Public Health Res Pract. 2017 Oct 11;27(4):
pubmed: 29114712
JAMA. 2011 Sep 7;306(9):942-51
pubmed: 21900134
Am J Epidemiol. 2002 Sep 1;156(5):471-82
pubmed: 12196317
JAMA Surg. 2014 May;149(5):475-81
pubmed: 24623106
Ann Surg. 2020 Mar;271(3):427-430
pubmed: 31460880
J Vasc Surg. 2019 Sep;70(3):786-794.e2
pubmed: 31204218
Int J Epidemiol. 1995 Feb;24(1):165-76
pubmed: 7797339
Br J Anaesth. 2020 Jan;124(1):73-83
pubmed: 31860444
Ann Vasc Surg. 2020 Jan;62:76-82
pubmed: 31201969
J Epidemiol Community Health. 1994 Aug;48(4):333-7
pubmed: 7964329
J Thorac Cardiovasc Surg. 2020 Aug;160(2):425-432.e9
pubmed: 31543309
Popul Health Metr. 2013 Jan 29;11(1):1
pubmed: 23360645
JAMA Surg. 2015 May;150(5):457-64
pubmed: 25786199
Acta Obstet Gynecol Scand. 2014 Sep;93(9):926-34
pubmed: 24957782
ANZ J Surg. 2019 Dec;89(12):1537-1538
pubmed: 31846571
Am J Public Health. 2006 Dec;96(12):2113-21
pubmed: 17077411
J Clin Oncol. 2016 Aug 20;34(24):2874-80
pubmed: 27325865
Heart Lung Circ. 2013 Aug;22(8):599-605
pubmed: 23541626
J Trauma Acute Care Surg. 2014 Sep;77(3):409-16
pubmed: 25159243
J Clin Epidemiol. 2004 Dec;57(12):1288-94
pubmed: 15617955
Heart Lung Circ. 2010 May-Jun;19(5-6):295-8
pubmed: 20356787
Ann Thorac Surg. 2016 Nov;102(5):1660-1667
pubmed: 27476821