Newly Published
Perioperative Medicine  |   January 2020
Socioeconomic Status and Days Alive and Out of Hospital after Major Elective Noncardiac Surgery: A Population-based Cohort Study
Author Notes
  • From the Department of Anesthesia (A.J.), Division of Cardiology (D.T.K., H.C.W.), Division of Cardiac Surgery (S.F.), Sunnybrook Research Institute (A.J., P.C.A., D.T.K., H.C.W., S.F.), Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Anesthesia, University of Toronto, Toronto, Canada (A.J., D.N.W.); Institute of Clinical Evaluative Sciences (ICES), Toronto, Canada (A.J., P.C.A., D.T.K., H.C.W., S.F., D.M., D.N.W.); Toronto General Hospital Research Institute, Toronto, Canada (A.J.); Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada (D.N.W.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication April 15, 2019. Accepted for publication December 10, 2019.
    Submitted for publication April 15, 2019. Accepted for publication December 10, 2019.×
  • Correspondence: Address correspondence to Dr. Jerath: Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Angela.Jerath@mail.utoronto.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Endocrine and Metabolic Systems / Practice Management / Respiratory System / Thoracic Anesthesia
Perioperative Medicine   |   January 2020
Socioeconomic Status and Days Alive and Out of Hospital after Major Elective Noncardiac Surgery: A Population-based Cohort Study
Anesthesiology Newly Published on January 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003123
Anesthesiology Newly Published on January 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003123
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Low socioeconomic status likely impairs many aspects of health and health care

  • Days alive and out of hospital is a new outcome measure that assesses duration of hospitalization and readmission

What This Article Tells Us That Is New:

  • The investigators evaluated more than 700,000 patients who had 13 types of surgery

  • Days alive and out of hospital in the initial postoperative months was about a quarter of a day shorter in the lowest than the highest socioeconomic quintile, adjusted for potential confounding factors

  • Confounder-adjusted serious complications were also more common in the lowest quintile (5% vs. 3.9%), as was mortality (0.6% vs. 0.4%)

Background: Socioeconomic status is an important but understudied determinant of preoperative health status and postoperative outcomes. Previous work has focused on the impact of socioeconomic status on mortality, hospital stay, or complications. However, individuals with low socioeconomic status are also likely to have fewer supports to facilitate them remaining at home after hospital discharge. Thus, such patients may be less likely to return home over the short and intermediate term after major surgery. The newly validated outcome, days alive and out of hospital, may be highly suited to evaluating the impact of socioeconomic status on this postdischarge period. The study aimed to determine the association of socioeconomic status with short and intermediate term postoperative recovery as measured by days alive and out of hospital.

Methods: The authors evaluated data from 724,459 adult patients who had one of 13 elective major noncardiac surgical procedures between 2006 and 2017. Socioeconomic status was measured by median neighborhood household income (categorized into quintiles). Primary outcome was days alive and out of hospital at 30 days, while secondary outcomes included days alive and out of hospital at 90 and 180 days, and 30-day mortality.

Results: Compared to the highest income quintile, individuals in the lowest quintile had higher unadjusted risks of postoperative complications (6,049 of 121,099 [5%] vs. 6,216 of 160,495 [3.9%]) and 30-day mortality (731 of 121,099 [0.6%] vs. 701 of 160,495 [0.4%]) and longer mean postoperative length of stay (4.9 vs. 4.4 days). From lowest to highest income quintile, the mean adjusted days alive and out of hospital at 30 days after surgery varied between 24.5 to 24.9 days.

Conclusions: Low socioeconomic status is associated with fewer days alive and out of hospital after surgery. Further research is needed to examine the underlying mechanisms and develop posthospital interventions to improve postoperative recovery in patients with fewer socioeconomic resources.