Community-level social capital and postoperative outcomes following intracranial tumor surgery: an exploration of the Social Capital Atlas in neurosurgical oncology.

BACKGROUND AND

OBJECTIVES

Explore whether community social capital measures (system of resources available to individuals through community engagement) are related to surgical outcomes among intracranial tumor patients.

METHODS

Adults who underwent resection at a single medical center for intracranial tumor was identified and their zip codes were matched to three variables derived from the Social Capital Atlas: economic connectedness, volunteering rate, and civic organizations. The economic connectedness score quantifies the degree to which low-income and high-income community members are friends with each other, the volunteering rate is defined as the proportion of a given community engaged in community organizations and the civic organization score is defined as the number of local civic organizations within a given community. Chi-square and Mann-Whitney U tests were used to compare demographic and clinical characteristics between patients who were in the > 75 and < 25 percentiles of each social capital measure. Multivariate logistic regression was used to assess the effect of social capital measures on postoperative outcomes.

RESULTS

A total of 2,373 patients were included in the present study. A majority were white (70.7%) and female (53%); the most common diagnosis was meningioma (24.0%). On multivariate analysis, for every additional civic organization in a patient's community per 1,000 community members, odds of extended hospital LOS, high hospital costs, and nonroutine discharge disposition was reduced by 60.3% (p = 0.006), 63.4% (p = 0.008) and 68.9% (p = 0.013) respectively. Further, for each point increase in community economic connectedness score and each percent increase in community volunteering rate, odds of extended LOS were reduced by 13.1% (p = 0.036) and 23.0% (p = 0.011), respectively.

CONCLUSION

Intracranial tumor patients with low social capital are at-risk for poor high-value care outcomes that may be amenable to case management or social work intervention.