Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-01-09 DOI:10.1177/00031348251314151

Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh

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引用次数: 0

Abstract

Aims: The aim was to determine the effect of socioeconomic deprivation on operative mortality after emergency laparotomy.

Methods: A PRISMA-compliant systematic review and meta-analysis (random-effects modeling) was performed searching for studies comparing operative mortality between the least and the most socioeconomically deprived patients undergoing emergency laparotomy. Both unadjusted and adjusted odds ratio (OR) were calculated as summary measure. Risk of bias was assessed using the Quality In Prognosis Studies tool, and certainty of evidence was assessed using the GRADE system.

Results: Four studies comprising 87,690 patients were included. There was no difference in the risk of operative mortality between the most and least deprived groups (unadjusted OR: 1.57, 95% CI .92, 2.68, P = .100) and when adjusted for other predictors (adjusted OR: 1.11, 95% CI .93, 1.32, P = .230). Subgroup analysis showed consistency of the findings in the United Kingdom (unadjusted OR: 1.36, 95% CI .92, 2.01, P = .130; adjusted OR: 1.15, 95% CI .92, 1.43, P = .230) and in the United States (unadjusted OR: 1.75, 95% CI .75, 4.06, P = .190; adjusted OR: 1.01, 95% CI .79, 1.29, P = .940). Sensitivity analyses showed inconsistency in favor of higher mortality risk in the most deprived patients. The GRADE certainty was moderate.

Conclusions: Socioeconomic deprivation may have minor effect on operative mortality after emergency laparotomy; however, such effect fades away once adjusted for other predictors of mortality. Although independent research is required, it may be reasonable to predict that incorporation of socioeconomic deprivation into preoperative risk assessment tools may not improve their predictive performance.

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紧急剖腹手术后社会经济剥夺与手术死亡风险：系统回顾和荟萃分析。

目的：目的是确定社会经济剥夺对急诊剖腹手术后手术死亡率的影响。方法：采用符合prisma标准的系统评价和荟萃分析（随机效应模型），寻找比较急诊剖腹手术中社会经济条件最贫困和最贫困患者手术死亡率的研究。计算未调整和调整后的比值比（OR）作为汇总指标。使用预后质量研究工具评估偏倚风险，使用GRADE系统评估证据的确定性。结果：四项研究共纳入87,690例患者。最贫困组和最贫困组的手术死亡率风险无差异（未校正OR: 1.57, 95% CI 0.92, 2.68, P = 0.100），经其他预测因素校正后（校正OR: 1.11, 95% CI 0.93, 1.32, P = 0.230）。亚组分析显示英国研究结果的一致性(未调整OR: 1.36, 95% CI: 0.92, 2.01, P = 0.130；校正OR: 1.15, 95% CI .92, 1.43, P = .230)和美国(未校正OR: 1.75, 95% CI .75, 4.06, P = .190；调整OR: 1.01, 95% CI: 0.79, 1.29, P = 0.940)。敏感性分析显示，在最贫困的患者中，死亡率风险较高的观点并不一致。GRADE确定性为中等。结论：社会经济剥夺对急诊剖腹手术死亡率影响较小；然而，一旦根据其他死亡率预测因素进行调整，这种影响就会消失。虽然需要独立的研究，但可以合理地预测，将社会经济剥夺纳入术前风险评估工具可能不会提高其预测性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.