The following is the summary of “Neighborhood Deprivation, Hospital Quality, and Mortality After Cancer Surgery” published in the January 2023 issue of Surgery by Bonner, et al.
The goal of this study is to determine if there is a correlation between access to high-quality cancer care at specialized hospitals and a narrowing of the gap between residents of the most and least disadvantaged communities. It is well-established that social risk factors are associated with poorer surgical outcomes for patients undergoing high-risk cancer surgeries. However, it is less well understood how much hospital quality can counteract the negative effects of neighborhood socioeconomic deprivation as a social risk factor.
Researchers reviewed data from 2014-2018 on 212,962 Medicare patients over the age of 65 who had one of the following procedures performed: liver resection, rectal resection, lung resection, esophagectomy, or pancreaticoduodenectomy due to cancer. Hospitals were categorized into 5 quality quintiles based on their 30-day postoperative mortality rates after adjusting for clinical risk factors. Area Deprivation Index quintiles were used to classify recipients. We analyzed the connection between hospital quality and neighborhood disadvantage regarding 30-day mortality using logistic regression. The average (SD) age of the 212,962 people in the cohort was 73.8 (5.7) years old; 109,419 (51%) of them were male. Patients from the most impoverished areas had higher risk-adjusted mortality at low-quality hospitals, regardless of the type of surgery they underwent: esophagectomy, 22.3% versus 20.7%; (P<0.003), liver resection, 19.3% versus 16.4%; (P<0.001), pancreatic resection, 15.9% versus 12.9%; (P<0.001), lung resection, 8.3% versus 7.8%; (P<0.001), rectal resection, 8.
When comparing people from the most and least disadvantaged areas, esophagectomy, rectal resection, liver resection, and pancreatectomy surgery at a high-quality hospital was not associated with any significant changes in mortality. For instance, esophagectomy patients from the most impoverished areas had a greater adjusted risk of death at low-quality hospitals (odds ratio=1.22, 95% CI: 1.14-1.31, P<0.001) than those from the least impoverished areas (odds ratio=0.98, 95% CI: 0.94-1.02, P=0.03). No significant variations in mortality were found between people residing in the most and least poor areas after they received difficult cancer surgery at a high-quality hospital. Improvements in outcomes and reduced inequalities may result from efforts to enhance referrals to high-quality hospitals for patients from high-deprivation areas.
