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Retrospective Analysis of the Area Deprivation Index and the Risk of Postoperative Adverse Events
Ali A. Nimeri
*, Daniel Uzochukwu, Obinnaya Okereke, Zachary Ballinger, Marcus McKenzie, Adam Skura, AbdulAziz Khan, Amalia PenaPerez, Richard A. Perugini
UMass Chan School of Medicine, Sharon, MA
Background: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is a nationally validated, risk-adjusted, outcomes-based program designed to improve the quality of surgical care. It uses data gathered from medical charts by clinically trained personnel and includes demographics, preoperative risk factors, and intraoperative to 30-day postoperative outcomes data. Although neighborhood measures of deprivation have been associated with morbidity and mortality following surgical interventions such as colectomy, coronary artery bypass grafting, lung resection, and emergency surgery, ACS NSQIP does not include neighborhood-level deprivation in its risk calculations. The Area Deprivation Index (ADI) allows for rankings of neighborhoods by socioeconomic factors in the domains of income, education, employment, and housing quality. The association between ADI and adverse events included in the NSQIP registry has yet to be fully elucidated. We investigated the relationship between ADI and postoperative adverse events in a metropolitan, tertiary care hospital.
Methods: This retrospective cohort study included patients who underwent surgery between January 2022 and June 2024 and were entered into the NSQIP registry. Adverse events were defined by NSQIP registry criteria. ADI national percentile and state decile were determined. Patients for whom ADI could not be calculated were excluded. Temporal trends of adverse events following sleeve gastrectomy were studied using CUSUM. Univariate and multivariate analyses narrowed using backward selection were carried out to identify factors predictive of adverse events.
Results: 4,849 patients were included in the final sample. The most common surgical specialties were General Surgery (36%), Gynecology (30%), and Orthopedic surgery (15%) respectively. The postoperative adverse event rate was 22%. The average ADI rank was significantly higher in patients with postoperative adverse events compared to those without an adverse event in univariate analysis (x= 38.8 vs 36.8 respectively, p=0.003). Within the General Surgery cohort, the same findings were seen (x= 37.9 vs 35.7 respectively, p= 0.016). Increasing ADI rank was significantly correlated with the presence of a postoperative adverse event in multivariable models factoring for age, race, surgical subspecialty, comorbidities, and case acuity. (OR: 1.009, CI: 1.004-1.01, p<0.001) (Table 1).
Conclusion: Increasing ADI rank was found to have a significant correlation with the presence of postoperative adverse events. Neighborhood level of deprivation is not presently included in the ACS NSQIP models for assessing risk. The results of this study indicate a need for further investigation into the inclusion of ADI in the calculation of operative risk and its merit as a factor for grading hospital quality.
Table 1: Multivariable Logistic Model of Postoperative Adverse Event
Had Occurance
| Odds ratio | [95% confidence | interval] | P value |
| Age at Time of Surgery | 1.022456 | 1.016458 | 1.028491 | <0.001
|
| Surgical Speciality | | | | |
| Orthopedics | 0.5077938
| 0.3937405
| 0.6548845
| <0.001
|
| Neurosurgery | 0.5292657
| 0.315623
| 0.8875214
| 0.016
|
| Cardiothoracic | 8.43314
| 6.044085
| 11.76652
| <0.001
|
| Race | | | | |
| Black or African American | 1.780389
| 1.251002
| 2.533798
| 0.001
|
| Robotic | 0.4846623
| 0.3777309
| 0.6218647
| <0.001
|
| Any Comorbidity | 1.71836
| 1.400389
| 2.108529
| <0.001
|
| ADI National Rank | 1.009168
| 1.004136
| 1.014225 | <0.001
|
| Case Acuity Emergent | 2.36561
| 1.935527
| 2.891259
| <0.001
|
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