Researchers from Michigan Medicine and other institutions have discovered that living in an under-resourced neighborhood might impact a person’s recovery from surgery, regardless of the quality of the hospital where the surgery was performed.
The scientists analyzed the 30-day post-operative death rate for five common operations for nearly 2 million patients covered by Medicare.
They assessed whether this rate was linked to the quality of the hospital (as determined by the Centers for Medicare & Medicaid Services) and/or the patients’ zip codes.
Neighborhood Factors Increase Post-surgery Death Risk
The team found considerable variation across the United States for both measures.
They discovered that a patient’s place of residence did not predict whether their operations would take place at high- or low-quality hospitals.
However, living in neighborhoods characterized by high poverty levels, low education rates, and poor-quality housing increased the likelihood of patient death after surgery, irrespective of whether the surgery was conducted at a high-quality hospital.
On the other hand, undergoing surgery at a lower-quality hospital exposed patients to a similar risk of post-operative death, even if they lived in neighborhoods with higher incomes and education levels.
Patients living in under-resourced neighborhoods and receiving surgeries at low-quality hospitals had the highest death rate.
Policies to Incentivize Structural Equity
The findings underscore the need for community benefit and other policies aimed at encouraging investments in and examination of the roles hospitals play in advancing structural equity in the communities they serve.
Healthcare systems are increasingly developing pilot programs to identify patients from neighborhoods at increased risk of poor surgical outcomes and to design programs to improve these patients’ health before surgery.
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The study, conducted by Adrian Diaz and his team, was published in JAMA Network Open.
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