American journal of surgery · 2025
Short-term outcomes following gastrectomy for adenocarcinoma: Assessing the role of social determinants of health.
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Moten Ambria S, Bailey Clark, Stanfill Ansley G, Glazer Evan S
Аннотация
BACKGROUND: It is unclear how social determinants of health (SDoH) impact short-term outcomes following gastrectomy for adenocarcinoma.
METHODS: Patients with stages I-III gastric adenocarcinoma who underwent gastrectomy were identified in the National Cancer Database. Adjusted regression analyses identified SDoH (race, insurance, income, education) associated with length of stay (LOS), 30-day readmission, and 30-day mortality.
RESULTS: Among 22,341 patients, the median age was 66 years and 68.5 % were White. Extended LOS was less likely among Black (OR = 0.75; 95 %CI:0.69-0.82), Hispanic (OR = 0.71; 95 %CI:0.65-0.79), and Asian patients (OR = 0.50; 95 %CI:0.45-0.56) compared to White patients, and less likely among patients from high-income rather than low-income regions (OR = 0.76; 95 %CI:0.69-0.85). Both extended LOS (OR = 1.19; 95 %CI:1.06-1.33) and readmission (OR = 1.26; 95 %CI:1.07-1.49) were more likely among patients with higher rather than lower regional education levels. Mortality was less likely among Asian than White patients (OR = 0.60; 95 %CI:0.42-0.87).
CONCLUSION: Improving education and anticipating postoperative needs may lead to less disparate outcomes.
METHODS: Patients with stages I-III gastric adenocarcinoma who underwent gastrectomy were identified in the National Cancer Database. Adjusted regression analyses identified SDoH (race, insurance, income, education) associated with length of stay (LOS), 30-day readmission, and 30-day mortality.
RESULTS: Among 22,341 patients, the median age was 66 years and 68.5 % were White. Extended LOS was less likely among Black (OR = 0.75; 95 %CI:0.69-0.82), Hispanic (OR = 0.71; 95 %CI:0.65-0.79), and Asian patients (OR = 0.50; 95 %CI:0.45-0.56) compared to White patients, and less likely among patients from high-income rather than low-income regions (OR = 0.76; 95 %CI:0.69-0.85). Both extended LOS (OR = 1.19; 95 %CI:1.06-1.33) and readmission (OR = 1.26; 95 %CI:1.07-1.49) were more likely among patients with higher rather than lower regional education levels. Mortality was less likely among Asian than White patients (OR = 0.60; 95 %CI:0.42-0.87).
CONCLUSION: Improving education and anticipating postoperative needs may lead to less disparate outcomes.