Shahab Hajibandeh, Anastasia Efstathiou, Shahin Hajibandeh, Ahmad Al-Sarireh, Hashim Al-Sarireh, Hamza Duffaydar, Michael Stechman, Richard John Egan, Wyn G Lewis
{"title":"Prognostic significance of socioeconomic deprivation in patients undergoing emergency laparotomy: A retrospective cohort study.","authors":"Shahab Hajibandeh, Anastasia Efstathiou, Shahin Hajibandeh, Ahmad Al-Sarireh, Hashim Al-Sarireh, Hamza Duffaydar, Michael Stechman, Richard John Egan, Wyn G Lewis","doi":"10.1002/wjs.12332","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Deprivation is a complex, multifaceted concept and not synonymous with poverty. The aim of this study was to assess the prognostic influence of the multiple deprivation index on emergency laparotomy (EL) outcome.</p><p><strong>Methods: </strong>STROCSS statement standards were followed to conduct a retrospective cohort study. Consecutive 1723 adult patients [median age (range): 66 (18-98), 762 M, and 961 F] undergoing EL over eight years (2014-22) at two hospitals [a tertiary teaching center and district general hospital (DGH)] were studied. Deprivation scores and ranks were derived from patients' postcodes using the Welsh Index of Multiple Deprivation and ranks categorized into quartiles. Primary outcome measure was a 30-day operative mortality (OM).</p><p><strong>Results: </strong>OM risk was higher in the most deprived quartile (Q1) compared with the least deprived quartile (Q4) (13.2% vs. 7.9% and p = 0.008). Deprivation was an independent predictor of OM on both univariate (unadjusted OR: 1.75, 95% CI 1.17-2.61, and p = 0.006) and multivariable logistic regression analyses (OR: 1.03, 95% CI 1.01-1.06, and p = 0.023; adjusted for age ≥80 years, American Society of Anesthesiologists grade, need for bowel resection, and peritoneal contamination). Deprivation had poor discriminatory value in predicting OM (AUC: 0.56 and 95% CI 0.54-0.59). Subgroup analysis showed that although the risk of OM was lower in the tertiary center compared with the DGH (7.9% vs. 14.5% and p < 0.001), the predictive significance of deprivation was similar in both hospitals (AUC: 0.54 vs. 0.56 and p = 0.674).</p><p><strong>Conclusion: </strong>Deprivation is an independent but modest predictor of OM after EL. The potential prognostic value of incorporating deprivation into preoperative risk assessment algorithms deserves further evaluation.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.12332","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Deprivation is a complex, multifaceted concept and not synonymous with poverty. The aim of this study was to assess the prognostic influence of the multiple deprivation index on emergency laparotomy (EL) outcome.
Methods: STROCSS statement standards were followed to conduct a retrospective cohort study. Consecutive 1723 adult patients [median age (range): 66 (18-98), 762 M, and 961 F] undergoing EL over eight years (2014-22) at two hospitals [a tertiary teaching center and district general hospital (DGH)] were studied. Deprivation scores and ranks were derived from patients' postcodes using the Welsh Index of Multiple Deprivation and ranks categorized into quartiles. Primary outcome measure was a 30-day operative mortality (OM).
Results: OM risk was higher in the most deprived quartile (Q1) compared with the least deprived quartile (Q4) (13.2% vs. 7.9% and p = 0.008). Deprivation was an independent predictor of OM on both univariate (unadjusted OR: 1.75, 95% CI 1.17-2.61, and p = 0.006) and multivariable logistic regression analyses (OR: 1.03, 95% CI 1.01-1.06, and p = 0.023; adjusted for age ≥80 years, American Society of Anesthesiologists grade, need for bowel resection, and peritoneal contamination). Deprivation had poor discriminatory value in predicting OM (AUC: 0.56 and 95% CI 0.54-0.59). Subgroup analysis showed that although the risk of OM was lower in the tertiary center compared with the DGH (7.9% vs. 14.5% and p < 0.001), the predictive significance of deprivation was similar in both hospitals (AUC: 0.54 vs. 0.56 and p = 0.674).
Conclusion: Deprivation is an independent but modest predictor of OM after EL. The potential prognostic value of incorporating deprivation into preoperative risk assessment algorithms deserves further evaluation.
目标：贫困是一个复杂的、多方面的概念，并不等同于贫穷。本研究旨在评估多重贫困指数对急诊开腹手术（EL）结果的预后影响：方法：按照 STROCSS 声明标准进行回顾性队列研究。研究对象为8年间（2014-22年）在两家医院（一家三级教学中心和一家地区综合医院（DGH））接受急诊开腹手术的连续1723名成年患者[中位年龄（范围）：66（18-98），762名男性，961名女性]。根据威尔士多重贫困指数从患者的邮政编码中得出贫困分数和等级，并将等级分为四等分。主要结果指标为 30 天手术死亡率（OM）：最贫困四分位数（Q1）的手术死亡率风险高于最不贫困四分位数（Q4）（13.2% vs. 7.9%，P = 0.008）。在单变量分析（未调整 OR：1.75，95% CI 1.17-2.61，p = 0.006）和多变量逻辑回归分析（OR：1.03，95% CI 1.01-1.06，p = 0.023；已对年龄≥80 岁、美国麻醉医师协会等级、肠切除需求和腹膜污染进行调整）中，贫困都是 OM 的独立预测因素。贫困对预测 OM 的鉴别价值较低（AUC：0.56，95% CI 0.54-0.59）。亚组分析表明，虽然三级中心的OM风险低于DGH（7.9% vs. 14.5%，P贫困是EL术后发生OM的一个独立但适度的预测因素。将贫困纳入术前风险评估算法的潜在预后价值值得进一步评估。
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
