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Association of social determinants of health‐related diagnosis codes with postoperative outcomes

Background The association of an individual's social determinants of health‐related problems with surgical outcomes has not been well‐characterized. The objective of this study was to determine whether documentation of social determinants of a health‐related diagnosis code (Z code) is associate...

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Published in:World journal of surgery 2024-05, Vol.48 (5), p.1004-1013
Main Authors: Sullivan, Gwyneth A., Krishnan, Vaishnavi, Silver, Casey, Smith, Charesa, Raval, Mehul V., Gulack, Brian C., Shah, Ami N.
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container_end_page 1013
container_issue 5
container_start_page 1004
container_title World journal of surgery
container_volume 48
creator Sullivan, Gwyneth A.
Krishnan, Vaishnavi
Silver, Casey
Smith, Charesa
Raval, Mehul V.
Gulack, Brian C.
Shah, Ami N.
description Background The association of an individual's social determinants of health‐related problems with surgical outcomes has not been well‐characterized. The objective of this study was to determine whether documentation of social determinants of a health‐related diagnosis code (Z code) is associated with postoperative outcomes. Methods This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health‐related problems. The primary outcome was 30‐day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30‐day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes. Results Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health‐related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39–2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33–1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89–4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45–2.73). Conclusions Social determinants of health‐related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health‐related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.
doi_str_mv 10.1002/wjs.12135
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The objective of this study was to determine whether documentation of social determinants of a health‐related diagnosis code (Z code) is associated with postoperative outcomes. Methods This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health‐related problems. The primary outcome was 30‐day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30‐day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes. Results Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health‐related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39–2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33–1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89–4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45–2.73). Conclusions Social determinants of health‐related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health‐related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1002/wjs.12135</identifier><identifier>PMID: 38502094</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Female ; general surgery ; Humans ; length of stay ; Length of Stay - statistics &amp; numerical data ; Male ; Middle Aged ; morbidity ; Patient Readmission - statistics &amp; numerical data ; Postoperative Complications - epidemiology ; Quality Improvement ; Retrospective Studies ; social determinants of health ; Social Determinants of Health - statistics &amp; numerical data ; Surgical Procedures, Operative - statistics &amp; numerical data</subject><ispartof>World journal of surgery, 2024-05, Vol.48 (5), p.1004-1013</ispartof><rights>2024 The Authors. World Journal of Surgery published by John Wiley &amp; Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3205-d1db4cb7b691ec00577de97d24eea92d4ff48e1351efc4d6bd9de7037b9fea583</cites><orcidid>0000-0002-4922-7041</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38502094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sullivan, Gwyneth A.</creatorcontrib><creatorcontrib>Krishnan, Vaishnavi</creatorcontrib><creatorcontrib>Silver, Casey</creatorcontrib><creatorcontrib>Smith, Charesa</creatorcontrib><creatorcontrib>Raval, Mehul V.</creatorcontrib><creatorcontrib>Gulack, Brian C.</creatorcontrib><creatorcontrib>Shah, Ami N.</creatorcontrib><title>Association of social determinants of health‐related diagnosis codes with postoperative outcomes</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><description>Background The association of an individual's social determinants of health‐related problems with surgical outcomes has not been well‐characterized. The objective of this study was to determine whether documentation of social determinants of a health‐related diagnosis code (Z code) is associated with postoperative outcomes. Methods This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health‐related problems. The primary outcome was 30‐day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30‐day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes. Results Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health‐related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39–2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33–1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89–4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45–2.73). Conclusions Social determinants of health‐related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health‐related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Female</subject><subject>general surgery</subject><subject>Humans</subject><subject>length of stay</subject><subject>Length of Stay - statistics &amp; numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>morbidity</subject><subject>Patient Readmission - statistics &amp; numerical data</subject><subject>Postoperative Complications - epidemiology</subject><subject>Quality Improvement</subject><subject>Retrospective Studies</subject><subject>social determinants of health</subject><subject>Social Determinants of Health - statistics &amp; numerical data</subject><subject>Surgical Procedures, Operative - statistics &amp; numerical data</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kEtOwzAQQC0EoqWw4AIoS1ik9SffZVXxVSUWgFhGjj2hrpK4ZByq7jgCZ-QkpE1hx8rj0dOT5hFyzuiYUcon6yWOGWciPCBDFgjuc8HFIRlSEQXdzMSAnCAuKWVxRKNjMhBJSDlNgyHJp4hWGemMrT1beLtP6Wlw0FSmlrXD7XoBsnSL78-vBkrpQHvayLfaokFPWQ3orY1beCuLzq6g6Wwf4NnWKVsBnpKjQpYIZ_t3RF5urp9nd_788fZ-Np37SnAa-prpPFB5nEcpA0VpGMca0ljzAECmXAdFESTQHcmgUIGOcp1qiKmI87QAGSZiRC5776qx7y2gyyqDCspS1mBbzHgaJSnvgoUdetWjqrGIDRTZqjGVbDYZo9k2adYlzXZJO_Zir23zCvQf-duwAyY9sDYlbP43Za8PT73yB1z6hAc</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Sullivan, Gwyneth A.</creator><creator>Krishnan, Vaishnavi</creator><creator>Silver, Casey</creator><creator>Smith, Charesa</creator><creator>Raval, Mehul V.</creator><creator>Gulack, Brian C.</creator><creator>Shah, Ami N.</creator><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4922-7041</orcidid></search><sort><creationdate>202405</creationdate><title>Association of social determinants of health‐related diagnosis codes with postoperative outcomes</title><author>Sullivan, Gwyneth A. ; 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In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39–2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33–1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89–4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45–2.73). Conclusions Social determinants of health‐related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health‐related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.</abstract><cop>United States</cop><pmid>38502094</pmid><doi>10.1002/wjs.12135</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4922-7041</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Female
general surgery
Humans
length of stay
Length of Stay - statistics & numerical data
Male
Middle Aged
morbidity
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology
Quality Improvement
Retrospective Studies
social determinants of health
Social Determinants of Health - statistics & numerical data
Surgical Procedures, Operative - statistics & numerical data
title Association of social determinants of health‐related diagnosis codes with postoperative outcomes
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