Introduction
Marked outcomes disparities have been demonstrated between patients of high- and low socioeconomic status (SES) undergoing colorectal cancer (CRC) resection1,2. Past literature has focused on population-level SES disparities in CRC prevention, screening, treatment access, and overall mortality3-5. Fewer studies have examined hospital-level SES disparities. We examined the association between CRC postoperative outcomes and hospitals’ average patient socioeconomic status, with the ultimate goal of identifying high-performing Michigan hospitals that could serve as models for future quality improvement initiatives.
Methods
We performed a retrospective analysis using the Michigan Surgical Quality Collaborative CRC patient registry (2016-2020) and assigned an Area Deprivation Index (ADI) value to each patient. ADI scores range from 1-10, with 10 representing the most disadvantaged neighborhoods. We calculated mean patient ADI scores for each hospital in the database (n=21). We compared positive margin rate, postoperative complications, and 30-day readmission rates across hospitals by their mean ADI Values.
Results
Hospitals’ average patient ADI scores ranged from 3.3-6.9. Average positive margin rate ranged from 0% to 26% at individual hospitals. Positive margin rates were not statistically associated with higher ADI scores (p=0.8198). Complication rates ranged from 0 to 28%, and 30-day readmission rates ranged from 0% to 30%, with no statistically significant relationship with average ADI (p = 0.0683 and 0.1938, respectively).
Conclusions
In Michigan, hospitals achieve similar postoperative outcomes regardless of the SES of their average patient. This suggests that Michigan hospitals serving high- and low-SES patients deliver equal quality CRC surgical care. Study limitations include retrospective analysis and variation in hospital patient volume. Despite these limitations, our findings signal that there may be actionable steps that low-SES serving hospitals can take to achieve high-quality outcomes. Identifying these drivers in future studies could potentially reduce outcome disparities at lower-performing hospitals.
References
1. Sastow, Dahniel L., et al. "The disparity of care and outcomes for medicaid patients undergoing colectomy." Journal of Surgical Research 235 (2019): 190-201.
2. Park, Hyun S., et al. "Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009–2014." Journal of comparative effectiveness research 8.16 (2019): 1365-1379.
3. Bauer, Cici, et al. "County-level social vulnerability and breast, cervical, and colorectal cancer screening rates in the US, 2018." JAMA Network Open 5.9 (2022): e2233429-e2233429. 4. Carmichael, Heather, et al. "Social vulnerability is associated with increased morbidity following colorectal surgery." The American Journal of Surgery 224.1 (2022): 100-105.
5. Paro, Alessandro, et al. "Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes." Surgery 170.6 (2021): 1777-1784.
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