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Socioeconomic Status and Surgical Outcomes After Regional Pancreatectomy
Heidi Schmidt*, Nakul Valsangkar, E. Molly Kilbane, Alexandra P. Turner, Michael G. House, Nicholas J. Zyromski, Attila Nakeeb, C. Max Schmidt, Eugene P. Ceppa
Surgery, Indiana University School of Medicine, Indianapolis, IN
Background: The comparison of socioeconomic status (SES) and surgical outcomes has not received adequate attention in the peer-review literature. Patients with lower SES are presumed to suffer from higher rates of postoperative morbidity. The aim of this study was to determine whether or not the SES of a patient, established by their Median Household Income (MHI) at the time of surgery, correlates with increased morbidity following regional pancreatectomy.
Methods: A restrospective review of 1212 cases of pancreaticoduodenectomy and distal pancreatectomy was conducted at a single, high-volume institution between 2007 and 2013. Annual MHI was derived from patient ZIP codes as determined by U.S. Census data; patient groups were divided into higher and lower SES by their location above and below the median MHI of the entire sample ($46,934). All cases were monitored with complete 30-day outcomes through the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP). Two-way statistical analyses were performed between the patient categories, and SES was separately analyzed by surgery type.
Results: The higher SES group (n=607) as compared to the lower SES group (n=605) had a significantly higher MHI. The lower SES group had significantly greater length of stay (LOS) as well as higher rates of Body Mass Index (BMI), current smoker status, and chronic obstructive pulmonary disease. There were no significant differences noted in intraoperative variables, 30-day morbidity or mortality.
Conclusion: Lower SES does not appear to impart a greater risk of 30-day morbidity or mortality to patients undergoing regional pancreatectomy. This may suggest that lower SES is not a reliable criterion when assessing surgical risk for this patient population. Further study of this topic is warranted with prospective collection of household income and insurance coverage. | Patient Category | n | Age (yrs) | LOS | Mean MHI ($/year) | 30-day Mortality | 30-day Morbidity | 30-day Total Complication Rate | 30-day Readmit | | High SES (> or = $46934) | 607 | 60 | 10 | 59,305* | 2.14% | 21% | 34% | 9% | | Low SES ( < $46934) | 605 | 61 | 11+ | 39182 | 3.64% | 21% | 35% | 8% |
*p < 0.001 ^p<0.01 +p<0.05
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