Health Affairs, 2022
In vulnerable communities, surgery is more often unplanned
Older Medicare patients from the most socially vulnerable communities more often had unplanned surgery for conditions best treated with a scheduled operation.
Summary
Among fee-for-service Medicare patients ages 65–99 who had surgery for an abdominal aortic aneurysm, colorectal cancer or an incisional hernia in 2014–18, the risk-adjusted share of operations that were unplanned (urgent or emergency) rose step by step with county social vulnerability, from 33.5% in the least vulnerable communities to 36.2% in the most.
Risk-adjusted 30-day mortality was also higher in the most vulnerable communities (5.4% vs 5.0%), which the authors say largely reflects the higher share of unplanned operations.
Operations for aortic aneurysm, colorectal cancer and hernia were more often unplanned in the most socially vulnerable counties than in the least
Risk-adjusted share of operations that were unplanned
Adjusted odds ratio 1.14 vs lowest (p<0.001)
Risk-adjusted share of operations done as unplanned (urgent or emergent) surgery in counties with the lowest and the highest social vulnerability (CDC Social Vulnerability Index, 2018: lowest 0–20, highest 81–100), on a scale from 30% to 40%. The three middle quintiles fall between them: below average (21–40) 34.1%, average (41–60) 34.6% and above average (61–80) 35.4%. Covers abdominal aortic aneurysm repair, colectomy for colorectal cancer and incisional hernia repair among fee-for-service Medicare beneficiaries ages 65–99, 2014–18. Source: Zhang Y, Kunnath N, Dimick JB, Scott JW, Diaz A, Ibrahim AM. Health Aff (Millwood) 2022;41(5):671–679. doi:10.1377/hlthaff.2021.01615. Redrawn by the lab from published results.
Read the study
Zhang Y, Kunnath N, Dimick JB, Scott JW, Diaz A, Ibrahim AM. Social Vulnerability And Outcomes For Access-Sensitive Surgical Conditions Among Medicare Beneficiaries. Health Aff (Millwood). 2022;41(5):671–679. doi:10.1377/hlthaff.2021.01615
Data and how to cite
Download the data (CSV): unplanned surgery by social vulnerability, Health Affairs 2022
The values plotted above: unplanned surgery by social vulnerability, Health Affairs 2022.
How to cite: Zhang Y, Kunnath N, Dimick JB, Scott JW, Diaz A, Ibrahim AM. Social Vulnerability And Outcomes For Access-Sensitive Surgical Conditions Among Medicare Beneficiaries. Health Aff (Millwood). 2022;41(5):671–679. doi:10.1377/hlthaff.2021.01615