Area Deprivation Index (ADI) as a Predictor of Surgical Complications in Patients Undergoing Mastectomy.

Abstract

Introduction: Socioeconomic disparities significantly influence health outcomes, particularly in surgical care. The Area Deprivation Index (ADI), a comprehensive measure of neighborhood-level socioeconomic status, is increasingly recognized as a predictor of clinical outcomes. This study examines the association between ADI and postoperative complications in patients undergoing mastectomy, hypothesizing that higher ADI scores correlate with worse outcomes.

Methods: A retrospective cohort analysis was conducted using the ACS-NSQIP database to evaluate 1141 female patients who underwent mastectomy between 2017 and 2022. Patients were categorized into tertiles based on their ADI scores. Preoperative characteristics, surgical details, and 30-day postoperative outcomes were analyzed. Statistical significance was assessed using chi-square tests for categorical variables and ANOVA for continuous variables.

Results: Patients in the highest ADI tertile had significantly higher rates of medical complications (17.3%) compared to those in the lowest tertile (9.2%, P = .01). Pneumonia was notably more frequent in the most deprived group (4.7% vs. 0.8%, P = .01). Other complications, such as unplanned readmissions and surgical complications, showed no significant differences between tertiles. Black patients were disproportionately represented in the highest ADI tertile, highlighting intersectional disparities. Household income and insurance type varied significantly across ADI tertiles, reflecting broader socioeconomic inequities.

Conclusion: Higher ADI scores are associated with increased medical complications, particularly pneumonia, in mastectomy patients. These findings emphasize the importance of integrating socioeconomic factors into surgical risk assessments and developing targeted interventions to address disparities in care and outcomes.