Highlights
- •Children from high SVI areas more likely suffer serious postoperative complications.
- •SVI's effect on children's surgery persist after adjusting for individual level SDoH.
- •Area-based social determinants of health are linked to pediatric surgical disparities.
Abstract
Introduction
Area-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.
Methods
This 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.
Results
Among 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).
Conclusion
Neighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes
in apparently healthy children, which could serve as a target for community-based
intervention.
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 accessOne-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 SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: a cross-sectional study.Laryngoscope. 2019; 129: 995-1000
- Complications and risk factors for mortality during congenital heart surgery admissions.Ann Thorac Surg. 2007; 84: 147-155
- Race, preoperative risk factors, and death after surgery.Pediatrics. 2018; 141e20172221
- Racial disparities in cleft palate repair.Plast Reconstr Surg. 2019; 143
- Race, postoperative complications, and death in apparently healthy children.Pediatrics. 2020; e20194113https://doi.org/10.1542/peds.2019-4113
- The effect of race on outcomes for appendicitis in children: a nationwide analysis.Am J Surg. 2014; 207: 748-753
- Leveraging the social determinants of health: what works?.PLoS One. 2016; 11e0160217
- Patient socioeconomic status is an independent predictor of operative mortality.Ann Surg. 2010; 252
- Association between Medicaid status, social determinants of health, and bariatric surgery outcomes.Ann. Surg. Open Perspect. Surg. Hist. Educ. Clin. Approaches. 2021; 2 (e028–e028)
- Association of social vulnerability with the use of high-volume and Magnet recognition hospitals for hepatopancreatic cancer surgery.Surgery. 2021; 170: 571-578
- High social vulnerability and “textbook outcomes” after cancer operation.J Am Coll Surg. 2021; 232: 351-359
- Using the social vulnerability index to examine local disparities in emergent and elective cholecystectomy.J Surg Res. 2019; 243: 160-164
- Association of county-level vulnerability, patient-level race/ethnicity, and receipt of surgery for early-stage hepatocellular carcinoma.JAMA Surg. 2021; 156: 197-199
- Association of county-level social vulnerability with elective versus non-elective colorectal surgery.J Gastrointest Surg. 2021; 25: 786-794
- County-level social vulnerability is associated with worse surgical outcomes especially among minority patients.Ann Surg. 2021; 274: 881-891
- Patient social vulnerability and hospital community racial/ethnic integration: do all patients undergoing pancreatectomy receive the same care across hospitals?.Ann Surg. 2021; 274
- Can social vulnerability indices predict county trauma fatality rates?.J. Trauma Acute Care Surg. 2021; 91
- Social vulnerability subtheme analysis improves perioperative risk stratification in hepatopancreatic surgery.J Gastrointest Surg. 2022; https://doi.org/10.1007/s11605-022-05245-9
- Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes.Surgery. 2021; 170: 1777-1784
- Pediatric trauma in the California-Mexico border region: injury disparities by area deprivation index.J. Trauma Acute Care Surg. 2022; 92: 831-838
- The COVID-19 pandemic and associated rise in pediatric firearm injuries: a multi-institutional study.J Pediatr Surg. 2022; 57: 1370-1376
- Regional variation in rates of pediatric perforated appendicitis.J Pediatr Surg. 2017; 52: 1488-1491
- Impact of health insurance type on trends in newborn circumcision, United States, 2000 to 2010.Am J Publ Health. 2015; 105: 1943-1949
- Surgical deserts in California: an analysis of access to surgical care.J Surg Res. 2018; 223: 102-108
- & on behalf of the delivery of surgical care committee of the American academy of pediatrics section on surgery. Challenges in transition of care for patients with anorectal malformations: a systematic review and recommendations for comprehensive care.Dis Colon Rectum. 2018; 61
- Prevalence of active long-term problems in patients with anorectal malformations: a systematic review.Dis Colon Rectum. 2016; 59
- Longitudinal associations between neighborhood physical and social environments and incident type 2 diabetes mellitus: the multi-ethnic study of atherosclerosis (MESA).JAMA Intern Med. 2015; 175: 1311
- A New tool for epidemiology: the usefulness of dynamic-agent models in understanding place effects on health.Am J Epidemiol. 2008; 168: 1-8
- Neighborhood resources for physical activity and healthy foods and their association with insulin resistance.Epidemiology. 2008; 19: 146-157
- Neighborhood characteristics and hypertension.Epidemiology. 2008; 19: 590-598
- Pediatric American College of surgeons national surgical quality improvement program: feasibility of a novel, prospective assessment of surgical outcomes.J Pediatr Surg. 2011; 46: 115-121
- Measuring community vulnerability to natural and anthropogenic hazards: the centers for disease Control and prevention's social vulnerability index.J Environ Health. 2018; 80: 34-36
- An analysis of pediatric social vulnerability in the Pennsylvania trauma system.J Pediatr Surg. 2020; 55: 2746-2751
- The relationship between social vulnerability and COVID-19 incidence among Louisiana census tracts.Front Public Health. 2021; 8
- Geocoding Services Web Application Programming Interface (API).2021
- Caregiver Activation and Health Literacy in Pediatric Surgery.2021
- The impact of social determinants of health on the overall wellbeing of children: a review for the pediatric surgeon.J Pediatr Surg. 2022; 57: 587-597
- Social determinants of health are associated with postoperative outcomes in children with complicated appendicitis.J Surg Res. 2022; 279: 692-701
- Effect of parental education and household poverty on recovery after traumatic brain injury in school-aged children.Brain Inj. 2021; 35: 1371-1381
- Despite overall improvement in surgical outcomes since 2000, income-related disparities persist.Health Aff. 2013; 32: 1773-1780
- Household income as a predictor for surgical outcomes and opioid use after spine surgery in the United States.Global Spine J. 2022; 219256822110708https://doi.org/10.1177/21925682211070823
- Socioeconomic status and days alive and out of hospital after major elective noncardiac surgery.Anesthesiology. 2020; 132: 713-722
- The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare.PLoS One. 2018; 13e0191464
- J. L. H.R.4853 - 111th Congress (2009-2010): Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010.2010
- Unemployment insurance, health-related social needs, health care access, and mental health during the COVID-19 pandemic.JAMA Intern Med. 2021; 181: 699
Mayfield, R. Overview | UCSF San Francisco Wraparound Project. University of California San Francisco (https://wraparound.ucsf.edu/services/overview.aspx).
- Socially responsible surgery: building recognition and coalition.Front. Surg. 2017; 4
- Establishment of resilience in a challenging recovery at home after pediatric tonsil surgery—children’s and caregivers' perspectives.Paediatr. Neonatal Pain. 2021; 3: 75-86
- Experience with day stay surgery.J Pediatr Surg. 1980; 15: 21-25
- Medi-cal | covered CaliforniaTM.(Covered California)
- Mitigating disparity in children with acute appendicitis: impact of patient-driven protocols.J Pediatr Surg. 2021; 56: 663-667
- Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention.JAMA Pediatr. 2015; 169: 383-390
- State-level public insurance coverage and neonatal circumcision rates.Pediatrics. 2020; e20201475https://doi.org/10.1542/peds.2020-1475
- Effects of in-person navigation to address family social needs on child health care utilization: a randomized clinical trial.JAMA Netw Open. 2020; 3e206445
Article info
Publication history
Published online: September 26, 2022
Accepted:
September 18,
2022
Received in revised form:
August 27,
2022
Received:
April 18,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
