Abstract
Background
Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions
annually. Low-income EGS patients have higher rates of postoperative adverse events
(AEs) than high-income patients. This may be related to health care segregation (a
disparity in access to high-quality centers). The emergent nature of EGS conditions
and the limited number of EGS providers in rural areas may result in less health care
segregation and thereby less variability in EGS outcomes in rural areas. The objective
of this study was to assess the impact of income on AEs for both rural and urban EGS
patients.
Materials and methods
The National Inpatient Sample (2007-2014) was queried for patients receiving one of
10 common EGS procedures. Multivariate regression models stratified by income quartiles
in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based
factors were used to determine the rates of surgical AEs (mortality, complications,
and failure to rescue [FTR]).
Results
1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated
with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07
[1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher
odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52).
Conclusions
Lower income is associated with higher postoperative AEs in the urban setting but
not in a rural environment. This socioeconomic disparity in EGS outcomes in urban
settings may reflect health care segregation, a differential access to high-quality
health care for low-income patients.
Keywords
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Article Info
Publication History
Published online: September 12, 2019
Accepted:
August 15,
2019
Received in revised form:
July 8,
2019
Received:
May 30,
2019
Footnotes
Presented at a meeting at the Academic Surgical Congress, February 2019.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
