Neighborhood-Level Socioeconomic Vulnerability and Perioperative Complications in Hysterectomy for Benign Indications
To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions. This retrospective cohort study analyzed patients who underwent hysterectomy for benign indi...
Uloženo v:
| Vydáno v: | Obstetrics and gynecology (New York. 1953) Ročník 146; číslo 5; s. 718 |
|---|---|
| Hlavní autoři: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
01.11.2025
|
| Témata: | |
| ISSN: | 1873-233X, 1873-233X |
| On-line přístup: | Zjistit podrobnosti o přístupu |
| Tagy: |
Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
|
| Abstract | To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions.
This retrospective cohort study analyzed patients who underwent hysterectomy for benign indications (2015-2024) using the Vizient Clinical Database. Patients were categorized into VVI quartiles (quartile 1, least vulnerable; quartile 4, most vulnerable) based on census tract data across nine socioeconomic domains: public safety, transportation, social cohesion, environmental quality, housing, neighborhood resources, health care access, education, and income. The primary outcome was the occurrence of perioperative complications, classified as major, minor, or any complication, with the Clavien-Dindo scale. Logistic regression was used to estimate the association between neighborhood vulnerability and surgical complications. Additional analyses evaluated the association of specific individual- and neighborhood-level social determinants, with race included as a marker of structural racism exposure, and perioperative outcomes.
Among 1,055,338 patients, 18.4% (n=194,002) experienced complications, including 4.4% (n=46,356) major and 16.0% (n=169,361) minor complications. Complication rates increased proportionally across VVI quartiles ( P <.001). Major complications rose from 3.6% in quartile 1 to 5.7% in quartile 4; minor complications increased from 13.8% to 19.8%; and any complications increased from 15.9% to 22.5%. Higher VVI quartiles were associated with increased odds of major, minor, and any complications compared with quartile 1, with the strongest effects in quartile 4. After adjustment, the association remained significant for quartiles 3 and 4. Comorbidities were the strongest individual-level predictor. Black race, as a marker of structural racism exposure, was independently associated with complication risk across all VVI quartiles.
We demonstrate that VVI, a measure of neighborhood-level social vulnerability, is associated with perioperative complications at the time of hysterectomy for benign indications independently of individual-level factors. Patients in the two most vulnerable quartiles experienced poorer outcomes compared with those in the least vulnerable quartile. Racial disparities, particularly affecting Black patients, persisted across VVI categories, reflecting the compounded influence of structural racism and neighborhood inequities. |
|---|---|
| AbstractList | To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions.OBJECTIVETo evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions.This retrospective cohort study analyzed patients who underwent hysterectomy for benign indications (2015-2024) using the Vizient Clinical Database. Patients were categorized into VVI quartiles (quartile 1, least vulnerable; quartile 4, most vulnerable) based on census tract data across nine socioeconomic domains: public safety, transportation, social cohesion, environmental quality, housing, neighborhood resources, health care access, education, and income. The primary outcome was the occurrence of perioperative complications, classified as major, minor, or any complication, with the Clavien-Dindo scale. Logistic regression was used to estimate the association between neighborhood vulnerability and surgical complications. Additional analyses evaluated the association of specific individual- and neighborhood-level social determinants, with race included as a marker of structural racism exposure, and perioperative outcomes.METHODSThis retrospective cohort study analyzed patients who underwent hysterectomy for benign indications (2015-2024) using the Vizient Clinical Database. Patients were categorized into VVI quartiles (quartile 1, least vulnerable; quartile 4, most vulnerable) based on census tract data across nine socioeconomic domains: public safety, transportation, social cohesion, environmental quality, housing, neighborhood resources, health care access, education, and income. The primary outcome was the occurrence of perioperative complications, classified as major, minor, or any complication, with the Clavien-Dindo scale. Logistic regression was used to estimate the association between neighborhood vulnerability and surgical complications. Additional analyses evaluated the association of specific individual- and neighborhood-level social determinants, with race included as a marker of structural racism exposure, and perioperative outcomes.Among 1,055,338 patients, 18.4% (n=194,002) experienced complications, including 4.4% (n=46,356) major and 16.0% (n=169,361) minor complications. Complication rates increased proportionally across VVI quartiles (P<.001). Major complications rose from 3.6% in quartile 1 to 5.7% in quartile 4; minor complications increased from 13.8% to 19.8%; and any complications increased from 15.9% to 22.5%. Higher VVI quartiles were associated with increased odds of major, minor, and any complications compared with quartile 1, with the strongest effects in quartile 4. After adjustment, the association remained significant for quartiles 3 and 4. Comorbidities were the strongest individual-level predictor. Black race, as a marker of structural racism exposure, was independently associated with complication risk across all VVI quartiles.RESULTSAmong 1,055,338 patients, 18.4% (n=194,002) experienced complications, including 4.4% (n=46,356) major and 16.0% (n=169,361) minor complications. Complication rates increased proportionally across VVI quartiles (P<.001). Major complications rose from 3.6% in quartile 1 to 5.7% in quartile 4; minor complications increased from 13.8% to 19.8%; and any complications increased from 15.9% to 22.5%. Higher VVI quartiles were associated with increased odds of major, minor, and any complications compared with quartile 1, with the strongest effects in quartile 4. After adjustment, the association remained significant for quartiles 3 and 4. Comorbidities were the strongest individual-level predictor. Black race, as a marker of structural racism exposure, was independently associated with complication risk across all VVI quartiles.We demonstrate that VVI, a measure of neighborhood-level social vulnerability, is associated with perioperative complications at the time of hysterectomy for benign indications independently of individual-level factors. Patients in the two most vulnerable quartiles experienced poorer outcomes compared with those in the least vulnerable quartile. Racial disparities, particularly affecting Black patients, persisted across VVI categories, reflecting the compounded influence of structural racism and neighborhood inequities.CONCLUSIONWe demonstrate that VVI, a measure of neighborhood-level social vulnerability, is associated with perioperative complications at the time of hysterectomy for benign indications independently of individual-level factors. Patients in the two most vulnerable quartiles experienced poorer outcomes compared with those in the least vulnerable quartile. Racial disparities, particularly affecting Black patients, persisted across VVI categories, reflecting the compounded influence of structural racism and neighborhood inequities. To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions. This retrospective cohort study analyzed patients who underwent hysterectomy for benign indications (2015-2024) using the Vizient Clinical Database. Patients were categorized into VVI quartiles (quartile 1, least vulnerable; quartile 4, most vulnerable) based on census tract data across nine socioeconomic domains: public safety, transportation, social cohesion, environmental quality, housing, neighborhood resources, health care access, education, and income. The primary outcome was the occurrence of perioperative complications, classified as major, minor, or any complication, with the Clavien-Dindo scale. Logistic regression was used to estimate the association between neighborhood vulnerability and surgical complications. Additional analyses evaluated the association of specific individual- and neighborhood-level social determinants, with race included as a marker of structural racism exposure, and perioperative outcomes. Among 1,055,338 patients, 18.4% (n=194,002) experienced complications, including 4.4% (n=46,356) major and 16.0% (n=169,361) minor complications. Complication rates increased proportionally across VVI quartiles ( P <.001). Major complications rose from 3.6% in quartile 1 to 5.7% in quartile 4; minor complications increased from 13.8% to 19.8%; and any complications increased from 15.9% to 22.5%. Higher VVI quartiles were associated with increased odds of major, minor, and any complications compared with quartile 1, with the strongest effects in quartile 4. After adjustment, the association remained significant for quartiles 3 and 4. Comorbidities were the strongest individual-level predictor. Black race, as a marker of structural racism exposure, was independently associated with complication risk across all VVI quartiles. We demonstrate that VVI, a measure of neighborhood-level social vulnerability, is associated with perioperative complications at the time of hysterectomy for benign indications independently of individual-level factors. Patients in the two most vulnerable quartiles experienced poorer outcomes compared with those in the least vulnerable quartile. Racial disparities, particularly affecting Black patients, persisted across VVI categories, reflecting the compounded influence of structural racism and neighborhood inequities. |
| Author | Bar-El, Liron Barba, N Brandon Kho, Rosanne M Shippey, Ernie Garcia-Filion, Pamela Orlando, Megan S |
| Author_xml | – sequence: 1 givenname: Liron surname: Bar-El fullname: Bar-El, Liron organization: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; the Department of Biomedical Informatics, University of Arizona College of Medicine-Phoenix, and the Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix/Banner University Medical Center, Phoenix, Arizona; Vizient Inc, Irving, Texas; and the Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado – sequence: 2 givenname: N Brandon surname: Barba fullname: Barba, N Brandon – sequence: 3 givenname: Ernie surname: Shippey fullname: Shippey, Ernie – sequence: 4 givenname: Pamela surname: Garcia-Filion fullname: Garcia-Filion, Pamela – sequence: 5 givenname: Rosanne M surname: Kho fullname: Kho, Rosanne M – sequence: 6 givenname: Megan S surname: Orlando fullname: Orlando, Megan S |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40966713$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkEtLw0AUhQep2If-A5FZukmdRzPJLGvRtlCs4AN3YTJz044kMzWTFPLvDWihZ3PuOXzcxRmjgfMOELqlZEqJTB7m2-WUnEmQVFygEU0THjHOvwZn9xCNQ_juISokv0LDGZFCJJSPUPsCdrfPfb333kQbOEKJ37y2HrR3vrIaf7alg1rltrRNh5Uz-BVq6w9919gj4IWvDqXVffAuYOvwqgsN1KAbX3W48DV-BGd3Dq-dOWHX6LJQZYCbf5-gj-en98Uq2myX68V8E2lOEhFR0KnRnBqiioKmOleiMLxgaQqSmJzEWuQx6FwmQoIhiZKx0OmMF6QQRhjOJuj-7--h9j8thCarbNBQlsqBb0PGWcwY4zJNevTuH23zCkx2qG2l6i47TcV-Aa4ccW0 |
| ContentType | Journal Article |
| Copyright | Copyright © 2025 by the American College of Obstetricians & Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2025 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2025 by the American College of Obstetricians & Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. – notice: Copyright © 2025 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1097/AOG.0000000000006086 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1873-233X |
| ExternalDocumentID | 40966713 |
| Genre | Journal Article |
| GroupedDBID | --- .XZ .Z2 01R 0R~ 123 1J1 2CO 354 40H 4Q1 4Q2 4Q3 5RE 5VS 77Y 7O~ 85S AAAAV AAAXR AAGIX AAHPQ AAIQE AAJCS AAMOA AAMTA AAQKA AARTV AASCR AASOK AASXQ AAUEB AAWTL AAXQO ABASU ABBUW ABDIG ABJNI ABPXF ABVCZ ABXVJ ABXYN ABZAD ABZZY ACBKD ACDDN ACDOF ACEWG ACGFO ACGFS ACILI ACLDA ACOAL ACWDW ACWRI ACXJB ACXNZ ACZKN ADBBV ADGGA ADHPY ADKSD ADSXY AEBDS AENEX AFBFQ AFDTB AFEXH AFFNX AFMBP AFNMH AFSOK AFUWQ AGINI AHOMT AHQNM AHQVU AHVBC AIJEX AINUH AJCLO AJIOK AJNWD AJZMW AKCTQ AKRWK AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AOQMC BAWUL BOYCO BQLVK BYPQX C45 CGR CS3 CUY CVF DIWNM DU5 E.X EBS ECM EEVPB EIF ERAAH EX3 F2K F2L F2M F2N F5P FCALG FD6 FDB FL- FW0 GNXGY GQDEL H0~ HLJTE HZ~ IKREB IKYAY IN~ IPNFZ JF9 JG8 JK3 JK8 K-A K-F K8S KD2 KMI L-C L7B MZP N9A NEJ NPM N~7 N~B O9- OAG OAH OBH ODMTH OHH OHYEH OL1 OLB OLG OLH OLU OLV OLY OLZ OPUJH OVD OVDNE OVIDH OVLEI OVOZU OWBYB OWU OWV OWX OWY OWZ OXXIT P2P RIG RLZ S4R S4S TEORI TSPGW TWZ UHB V2I VVN W3M WH7 WOQ WOW X3V X3W XXN XYM ZB8 ~S- 7X8 |
| ID | FETCH-LOGICAL-c3076-1ec8dc31d0aff18cba6fd3f288e90db05c6b5ecb9769ed07a956c843f0f6d6d32 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 0 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001597317500018&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1873-233X |
| IngestDate | Fri Sep 19 21:01:05 EDT 2025 Sun Oct 19 00:30:09 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 5 |
| Language | English |
| License | Copyright © 2025 by the American College of Obstetricians & Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c3076-1ec8dc31d0aff18cba6fd3f288e90db05c6b5ecb9769ed07a956c843f0f6d6d32 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 40966713 |
| PQID | 3252223987 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_3252223987 pubmed_primary_40966713 |
| PublicationCentury | 2000 |
| PublicationDate | 2025-November |
| PublicationDateYYYYMMDD | 2025-11-01 |
| PublicationDate_xml | – month: 11 year: 2025 text: 2025-November |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Obstetrics and gynecology (New York. 1953) |
| PublicationTitleAlternate | Obstet Gynecol |
| PublicationYear | 2025 |
| SSID | ssj0001693 |
| Score | 2.4877486 |
| Snippet | To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 718 |
| SubjectTerms | Adult Aged Female Humans Hysterectomy - adverse effects Hysterectomy - statistics & numerical data Middle Aged Neighborhood Characteristics - statistics & numerical data Postoperative Complications - epidemiology Postoperative Complications - etiology Residence Characteristics - statistics & numerical data Retrospective Studies Social Vulnerability Socioeconomic Factors |
| Title | Neighborhood-Level Socioeconomic Vulnerability and Perioperative Complications in Hysterectomy for Benign Indications |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/40966713 https://www.proquest.com/docview/3252223987 |
| Volume | 146 |
| WOSCitedRecordID | wos001597317500018&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8NAFB7UinhxX-rGCF6HJjPJZHKSWqwV2tiDSm8lmUUKOqnWCv33vslCvQiCOeSUhDDvzZvvbd9D6IrTDGCoDoivQAwBmD-ShoYSk4ZK0TTgviymlvSjJBGjUTysAm6zqqyytomFoVa5dDHyFqOhO8rARb6evhM3NcplV6sRGquowQDKOK2ORku2cEc04hwuETFCGRvVrXNx1Go_3JXUhdXFPcF_B5nFYdPd_u9v7qCtCmbidqkXu2hF2z20MagS6ftonriQKMjfsRqTvqscwkXviq4alfHz_NURUhe1swucWoWHoKz5VJdU4bjzsxYdTyzuOU5oZz_ztwUGKIxvtJ28WHxvVf3YAXrq3j52eqSawEAk7H1OfC2FksxXXmqML2SWcqOYoULo2FOZF0qehVpmgGlirbwoBW9LioAZz3DFFaOHaM3mVh8jnEnDPZlpwSMdRCIQhvqByRTVPODw1Sa6rBd0DBru0hap1fl8Nl4uaRMdlVIZT0sqjjF4p5yDn33yh7dP0SZ1w3uLRsIz1DCwv_U5Wpdfn5PZx0WhOnBPhoNvkJfQpg |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Neighborhood-Level+Socioeconomic+Vulnerability+and+Perioperative+Complications+in+Hysterectomy+for+Benign+Indications&rft.jtitle=Obstetrics+and+gynecology+%28New+York.+1953%29&rft.au=Bar-El%2C+Liron&rft.au=Barba%2C+N+Brandon&rft.au=Shippey%2C+Ernie&rft.au=Garcia-Filion%2C+Pamela&rft.date=2025-11-01&rft.issn=1873-233X&rft.eissn=1873-233X&rft_id=info:doi/10.1097%2FAOG.0000000000006086&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1873-233X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1873-233X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1873-233X&client=summon |