Community-level social capital and postoperative outcomes following intracranial tumor surgery: an exploration of the Social Capital Atlas in neurosurgical oncology.

Abstract

Background and objectives: Explore whether community social capital measures (system of resources available to individuals through community engagement) are related to surgical outcomes among intracranial tumor patients.

Methods: Adults who underwent resection at a single medical center for intracranial tumor was identified and their zip codes were matched to three variables derived from the Social Capital Atlas: economic connectedness, volunteering rate, and civic organizations. The economic connectedness score quantifies the degree to which low-income and high-income community members are friends with each other, the volunteering rate is defined as the proportion of a given community engaged in community organizations and the civic organization score is defined as the number of local civic organizations within a given community. Chi-square and Mann-Whitney U tests were used to compare demographic and clinical characteristics between patients who were in the > 75 and < 25 percentiles of each social capital measure. Multivariate logistic regression was used to assess the effect of social capital measures on postoperative outcomes.

Results: A total of 2,373 patients were included in the present study. A majority were white (70.7%) and female (53%); the most common diagnosis was meningioma (24.0%). On multivariate analysis, for every additional civic organization in a patient's community per 1,000 community members, odds of extended hospital LOS, high hospital costs, and nonroutine discharge disposition was reduced by 60.3% (p = 0.006), 63.4% (p = 0.008) and 68.9% (p = 0.013) respectively. Further, for each point increase in community economic connectedness score and each percent increase in community volunteering rate, odds of extended LOS were reduced by 13.1% (p = 0.036) and 23.0% (p = 0.011), respectively.

Conclusion: Intracranial tumor patients with low social capital are at-risk for poor high-value care outcomes that may be amenable to case management or social work intervention.