Association of hospital quality and social determinants of health with short-term surgical outcomes among medicare beneficiary patients undergoing elective cancer surgery.

BACKGROUND

Community-level sociodemographic factors and hospital quality are associated with access to cancer care and outcomes.

METHODS

Using Medicare data (2016-2018), we evaluated the association between social determinants of health (SDoH) and hospital quality with 30-day mortality and readmission after selected elective cancer surgery. Separate multivariable logistic regression models sequentially adjusted for comorbidities and SDoH factors (Social Vulnerability Index (SVI) and Distressed Communities Index (DCI)) and then Hospital Star Rating.

RESULTS

Among 16,869 patients, the "At Risk" DCI group and higher SVI were associated with higher 30-day mortality, and higher SVI was associated with higher odds of 30-day readmission and mortality. Subsequent models demonstrated that higher Hospital Star Rating was associated with lower odds of 30-day mortality and readmission and SDoH factors lost significance after adjusting for Hospital Star Rating.

CONCLUSIONS

Hospital quality may have a greater impact on short-term outcomes than SDoH factors.