Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California |
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| Institution: | 1. University of California San Francisco, Department of Surgery, USA;2. University of California San Francisco, School of Medicine, USA;3. University of California San Francisco, Department of Anesthesia, USA;4. Nationwide Children''s Hospital, Department of Anesthesiology and Pain Medicine, USA;1. University of South Dakota Sanford School of Medicine General Surgery Residency, Health Science Center, 1400 W 22nd St, Sioux Falls, SD, 57105, USA;2. Sanford Research, 2301 E 60th St, Sioux Falls, South Dakota, 57104, USA;3. Sanford USD Medical Center, 1305 W 18th St, Sioux Falls, South Dakota, 57117, USA;1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA;2. University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA;3. Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA |
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| Abstract: | IntroductionArea-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions.MethodsThis retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1–2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015–2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery.ResultsAmong 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio OR] 1.58, 95% confidence interval CI] 1.02–2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03–2.98).ConclusionNeighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention. |
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| Keywords: | Pediatric surgery Health equity Social determinants of health Postoperative outcomes Healthcare access |
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