Advertisement

Social determinants of health Z-codes and postoperative outcomes after colorectal surgery: A national population-based study

      Highlights

      • Social determinants of health were measured using ICD 9 and 10 codes.
      • 5% of patients undergoing colorectal surgery reported a social determinant of health.
      • Social determinants of health were associated with postoperative outcomes.

      Abstract

      Background

      We sought to evaluate the impact of social determinants of health (SDOH) on postoperative outcomes following colorectal surgery.

      Methods

      This retrospective cohort study used PearlDiver-Mariner, an all-payer insurance claims database. Patients who underwent colectomy or proctectomy between 2010 and 2020 were included. SDOH were identified using International Classification of Diseases diagnosis codes. Outcomes were compared using multivariable regression models.

      Results

      The 30-day postoperative complication rate among 333,387 patients (mean age, 59 years; 58% female) was 27%. Approximately 5% of patients reported at least one SDOH at baseline. SDOH were not associated with length of stay but were associated with higher odds of 30-day postoperative complications (OR:1.16, 95% CI:1.12–1.20), including urinary tract infection (OR:1.27, 95% CI:1.20–1.35) anastomotic leak (OR:1.22, 95% CI:1.16–1.28), pneumonia (OR:1.19, 95% CI:1.11–1.27), deep vein thrombosis (OR:1.13, 95% CI:1.02–1.23), sepsis (OR:1.12, 95% CI:1.07–1.18), disruption of wound (OR:1.12, 95% CI:1.03–1.21), and acute kidney injury (OR:1.04, 95% CI:0.99–1.10).

      Conclusions

      SDOH Z-codes were associated with worse postoperative complications following colorectal surgery and may help target high-risk patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Briggs A.
        • Goldberg J.
        Tips, tricks, and technique for laparoscopic colectomy.
        Clin Colon Rectal Surg. 2017; 30: 130-135https://doi.org/10.1055/s-0036-1597313
        • Crawshaw B.P.
        • Chien H.L.
        • Augestad K.M.
        • Delaney C.P.
        Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.
        JAMA Surg. 2015; 150: 410-415https://doi.org/10.1001/jamasurg.2014.3171
        • Bliss L.A.
        • Maguire L.H.
        • Chau Z.
        • et al.
        Readmission after resections of the colon and rectum: predictors of a costly and common outcome.
        Dis Colon Rectum. 2015; 58: 1164-1173https://doi.org/10.1097/DCR.0000000000000433
        • Li L.T.
        • Mills W.L.
        • White D.L.
        • et al.
        Causes and prevalence of unplanned readmissions after colorectal surgery: a systematic review and meta-analysis.
        J Am Geriatr Soc. 2013; 61: 1175-1181https://doi.org/10.1111/jgs.12307
      1. Grunvald MW, Underhill JM, Skertich NJ, et al. Mediating factors between race and time to treatment in colorectal cancer. Dis Colon Rectum. Published online December 20, 2021.

        • WHO Commission on Social Determinants of Health, World Health Organization
        Closing the Gap in a Generation : Health Equity through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report.
        World Health Organization, 2008
      2. Healthy People 2030 [Internet]. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion [cited March 3, 2021]. Available from: https://health.gov/healthypeople.

        • Braveman P.
        • Egerter S.
        • Williams D.R.
        The social determinants of health: coming of age.
        Annu Rev Publ Health. 2011; 32: 381-398https://doi.org/10.1146/annurev-publhealth-031210-101218
        • Blair A.
        • Marryat L.
        • Frank J.
        How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences.
        Int J Publ Health. 2019; 64: 1059-1068https://doi.org/10.1007/s00038-019-01258-5
        • Alcaraz K.I.
        • Wiedt T.L.
        • Daniels E.C.
        • Yabroff K.R.
        • Guerra C.E.
        • Wender R.C.
        Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy.
        CA Cancer J Clin. 2020; 70: 31-46https://doi.org/10.3322/caac.21586
        • Qi A.C.
        • Peacock K.
        • Luke A.A.
        • Barker A.
        • Olsen M.A.
        • Joynt Maddox K.E.
        Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
        JAMA Netw Open. 2019; 2e1912339https://doi.org/10.1001/jamanetworkopen.2019.12339
        • Park H.S.
        • White R.S.
        • Ma X.
        • Lui B.
        • Pryor K.O.
        Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009-2014.
        J Comp Eff Res. 2019; 8: 1365-1379https://doi.org/10.2217/cer-2019-0114
        • Sastow D.L.
        • White R.S.
        • Mauer E.
        • Chen Y.
        • Gaber-Baylis L.K.
        • Turnbull Z.A.
        The disparity of care and outcomes for Medicaid patients undergoing colectomy.
        J Surg Res. 2019; 235: 190-201https://doi.org/10.1016/j.jss.2018.09.056
        • Robinson C.N.
        • Balentine C.J.
        • Sansgiry S.
        • Berger D.H.
        Disparities in the use of minimally invasive surgery for colorectal disease.
        J Gastrointest Surg. 2012; 16: 897-904https://doi.org/10.1007/s11605-012-1844-3
        • McIntyre L.K.
        • Arbabi S.
        • Robinson E.F.
        • Maier R.V.
        Analysis of risk factors for patient readmission 30 Days following discharge from general surgery.
        JAMA Surg. 2016; 151: 855-861https://doi.org/10.1001/jamasurg.2016.1258
        • Poulton T.E.
        • Salih T.
        • Martin P.
        • Rojas-Garcia A.
        • Raine R.
        • Moonesinghe S.R.
        Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery.
        Br J Surg. 2018; 105: 959-970https://doi.org/10.1002/bjs.10848
        • Alves A.
        • Civet A.
        • Laurent A.
        • et al.
        Social deprivation aggravates postoperative morbidity in carcinologic colorectal surgery: results of the COINCIDE multicenter study [published online ahead of print, 2020 Jul 31].
        J Vis Surg. 2020; (S1878-7886(20)30212-5)https://doi.org/10.1016/j.jviscsurg.2020.07.007
        • Ghirimoldi F.M.
        • Schmidt S.
        • Simon R.C.
        • et al.
        Association of socioeconomic area deprivation index with hospital readmissions after colon and rectal surgery.
        J Gastrointest Surg. 2021; 25: 795-808https://doi.org/10.1007/s11605-020-04754-9
        • Healthcare Research PearlDiver
        https://www.pearldiverinc.com/researchinfo.html
        Date accessed: December 11, 2021
        • Manatt Phelps
        • Phillips L.L.P.
        Medicaid's Role in Addressing Social Determinants of Health.
        Robert Wood Johnson Foundation, 2019
        • Khalid S.I.
        • Maasarani S.
        • Nunna R.S.
        • et al.
        Association between social determinants of health and postoperative outcomes in patients undergoing single-level lumbar fusions.
        Spine. 2021; 46: 559-565https://doi.org/10.1097/BRS.0000000000003829
        • Lee J.
        • Fernando S.J.
        • Malenke J.A.
        • et al.
        Socioeconomic influences on short-term postoperative outcomes in patients with oral cavity cancer undergoing free flap reconstruction.
        Otolaryngology-Head Neck Surg (Tokyo). May 2021; https://doi.org/10.1177/01945998211012954
        • Khalid S.I.
        • Maasarani S.
        • Shanker R.M.
        • Becerra A.Z.
        • Omotosho P.
        • Torquati A.
        Social determinants of health and their impact on rates of postoperative complications among patients undergoing vertical sleeve gastrectomy [published online ahead of print.
        Surgery. 2021 Jul 21; https://doi.org/10.1016/j.surg.2021.06.023
        • Freij M.
        • Dullabh P.
        • Lewis S.
        • Smith S.R.
        • Hovey L.
        • Dhopeshwarkar R.
        Incorporating social determinants of health in electronic health records: qualitative study of current practices among top vendors.
        JMIR Med Inform. 2019; 7e13849https://doi.org/10.2196/13849
        • Guo Y.
        • Chen Z.
        • Xu K.
        • et al.
        International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records.
        Medicine (Baltim). 2020; 99e23818https://doi.org/10.1097/MD.0000000000023818
        • Truong H.P.
        • Luke A.A.
        • Hammond G.
        • Wadhera R.K.
        • Reidhead M.
        • Joynt Maddox K.E.
        Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016-2017.
        Med Care. 2020; 58: 1037-1043https://doi.org/10.1097/MLR.0000000000001418
        • Weeks W.B.
        • Cao S.Y.
        • Lester C.M.
        • Weinstein J.N.
        • Morden N.E.
        Use of Z-codes to record social determinants of health among fee-for-service Medicare beneficiaries in 2017.
        J Gen Intern Med. 2020; 35: 952-955https://doi.org/10.1007/s11606-019-05199-w
        • Mathew J.
        • Hodge C.
        • Khau M.
        Z Codes Utilization among Medicare Fee-for-Service (FFS) Beneficiaries in 2017.
        (CMS OMH Data Highlight No. 18) CMS Office of Minority Health, Baltimore, MD2020
        • Bensken W.P.
        • Alberti P.M.
        • Koroukian S.M.
        Health-related social needs and increased readmission rates: findings from the nationwide readmissions database [published online ahead of print, 2021 feb 25].
        J Gen Intern Med. 2021; (10.1007/s11606-021-06646-3)https://doi.org/10.1007/s11606-021-06646-3
        • Humana
        Humana Launches Innovative Value-Based Program to Address Social Determinants of Health.
        Humana Press Release, 2020
        • Coughlin S.S.
        Social determinants of colorectal cancer risk, stage, and survival: a systematic review.
        Int J Colorectal Dis. 2020; 35: 985-995https://doi.org/10.1007/s00384-020-03585-z
        • Jiménez Carrillo M.
        • Fernández Rodker J.
        • Sastre Paz M.
        • Menendez-Asenjo Á Alberquilla
        [does the electronic health record reflect the social determinants of health from primary health care? ].
        Atención Primaria. 2021; 53: 36-42
        • Vest J.R.
        • Wu W.
        • Mendonca E.A.
        Sensitivity and specificity of real-world social factor screening approaches.
        J Med Syst. 2021; 45: 111