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Publication Date

6-26-2020

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Presentation: 4:46

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Abstract

Background & Significance: Social determinants of health (SDoH) influence health outcomes in powerful, yet poorly understood ways. Thirty-day unplanned all-cause readmission (30dRA) after general surgery is a persistently concerning and costly adverse clinical outcome. Recent governmental efforts to reduce readmissions after certain procedures have highlighted the importance of understanding the factors that protect from or expose to the risk of readmission. We conducted a rapid review of the published literature to identify patient-related SDoH that generate disparities among surgical patients. Methods: PubMed and Scopus were queried for relevant English-language studies published between January 1, 2015 and February 15, 2020 evaluating 30dRA after general surgery in adult patients in the United States. Studies were included in this review only if they used a uni- or multivariable regression to assess relevant SDoH as predictors of 30dRA. Results: A total of 12 research studies met inclusion criteria out of 1,198 initial citations. A variety of procedures (e.g., colorectal resection, cholecystectomy) and indications for surgery (e.g., cancer, inflammatory bowel disease, appendicitis) were evaluated. SDoH that were studied among the articles were: race/ethnicity (75%), insurance status (67%), socioeconomic status (34%), patient location/travel distance (25%), discharge destination (17%), and education (17%). Non-white race, public insurance and non-routine discharge were consistently strong predictors of 30dRA. Conclusions: The disparities most commonly observed by studies did not capture the full spectrum of SDoH as described by Healthy People 2020. Testing unexplored determinants and re-evaluating traditionally studied ones should be a priority for future surgical research aimed to reduce readmissions and provide cost-effective, patient-centered care.

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English

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