Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study

Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting...

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Published in:	British journal of anaesthesia : BJA Vol. 124; no. 1; p. 73
Main Authors:	Poulton, Thomas E, Moonesinghe, Ramani, Raine, Rosalind, Martin, Peter
Format:	Journal Article
Language:	English
Published:	England 01.01.2020
Subjects:	Adolescent Adult Aged Aged, 80 and over Comorbidity Emergency Medical Services England - epidemiology Female Hospitals - statistics & numerical data Humans Laparotomy - mortality Male Middle Aged Perioperative Care - economics Perioperative Care - standards Postoperative Complications - economics Postoperative Complications - mortality Poverty Risk Adjustment Socioeconomic Factors State Medicine Young Adult England mortality socioeconomic factors healthcare disparities emergency laparotomy perioperative care surgery
ISSN:	1471-6771, 1471-6771
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Abstract	Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.
AbstractList	Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups.BACKGROUNDSocioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups.This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence.METHODSThis was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence.Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association.RESULTSOverall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association.More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.CONCLUSIONSMore-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit. Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.
Author	Martin, Peter Moonesinghe, Ramani Raine, Rosalind Poulton, Thomas E
Author_xml	– sequence: 1 givenname: Thomas E surname: Poulton fullname: Poulton, Thomas E email: t.e.poulton@doctors.org.uk organization: Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK; Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, UK. Electronic address: t.e.poulton@doctors.org.uk – sequence: 2 givenname: Ramani surname: Moonesinghe fullname: Moonesinghe, Ramani organization: Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK; Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, UK; Surgical Outcomes Research Centre, University College London, London, UK – sequence: 3 givenname: Rosalind surname: Raine fullname: Raine, Rosalind organization: Department of Applied Health Research, University College London, London, UK – sequence: 4 givenname: Peter surname: Martin fullname: Martin, Peter organization: Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK; Department of Applied Health Research, University College London, London, UK
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Contributor	Johnston, Carolyn Oliver, C M Kuryba, Angela Walker, Kate Lockwood, Sonia Lourtie, Jose Anderson, Iain D Cromwell, David A Davies, Emma Bassett, Mike G Grocott, Mike P W Eugene, Natalie Murray, Dave Peden, Carol Salih, Tom
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SubjectTerms	Adolescent Adult Aged Aged, 80 and over Comorbidity Emergency Medical Services England - epidemiology Female Hospitals - statistics & numerical data Humans Laparotomy - mortality Male Middle Aged Perioperative Care - economics Perioperative Care - standards Postoperative Complications - economics Postoperative Complications - mortality Poverty Risk Adjustment Socioeconomic Factors State Medicine Young Adult
Title	Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study
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