In a study from Michigan Medicine and elsewhere, scientists found that living in an under-resourced neighborhood may affect a person’s recovery from surgery, even if their operation takes place at a high-quality hospital.
They analyzed whether the death rate in the 30 days after five common operations was tied to hospital quality, as calculated by the Centers for Medicare & Medicaid Services, and/or zip code for close to 2 million patients covered by Medicare.
They found wide variation across the United States for both measures, including that where patients lived did not predict whether they underwent their operations at high- or low-quality hospitals.
However, living in a neighborhood with high poverty levels, low education rates and worse quality housing increased the likelihood that a patient died after surgery, whether their procedure took place at a high-quality hospital or not.
Similarly, undergoing surgery at a lower-quality hospital put patients at a similar risk of dying after their operations, even if they lived in neighborhoods with higher incomes and education levels.
The team found patients who both lived in under-resourced neighborhoods and underwent surgeries at low-quality hospitals had the highest death rate (all death rates were in the single digits.)
Patients from the most deprived neighborhoods going to the highest-rated hospitals have a similar risk of death as those in the least deprived neighborhoods going to the lowest-quality hospitals.
These findings support community benefit and other policies designed to incentivize investment in and examination of the roles hospitals play in advancing structural equity in the communities they serve.
The team says healthcare systems are increasingly developing pilot programs to identify patients who live in neighborhoods at increased risk of poor surgical outcomes and creating programs to try to improve those patients’ health before surgery.
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The study was conducted by Adrian Diaz et al and published in JAMA Network Open.
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