Social vulnerability is associated with more stomas after surgery for uncomplicated diverticulitis

Background

Previous research has demonstrated disparities in surgical management of diverticulitis based on various patient characteristics, including race. Recent investigation suggests environmental factors may also play a prominent role in patient outcomes. The Center for Disease Control and Prevention's Social Vulnerability Index (SVI) is emerging as a useful tool for studying this effect and may better characterize social determinants of health among colorectal pathology.

Methods

This was a retrospective review of patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2006–2014), matched by ZIP code to their corresponding SVI. Patients admitted through the emergency department with a primary diagnosis of diverticulitis were included. The rate of stoma creation amongst patients undergoing non-elective surgery for uncomplicated diverticulitis was compared by SVI.

Results

Of the 4,212 patients in this study who underwent colectomy, 2,310 (54.8%) received a stoma. Compared to those with low vulnerability, highly vulnerable patients were more likely to receive a stoma (p = 0.014). In multivariable logistic analysis, increasing vulnerability was independently associated with increased odds of stoma creation (OR 1.08, p<0.001). Female sex (OR 0.86, p = 0.027), nonwhite race (OR 0.63, p<0.001), and minimally invasive surgical approach (OR 0.41, p<0.001) were associated with decreased odds of stoma creation.

Conclusions

High social vulnerability was associated with stoma creation amongst patients who underwent non-elective surgery for uncomplicated diverticulitis. Contrarily, nonwhite race was associated with decreased rate of stoma creation, highlighting the importance of using more comprehensive metrics of patient vulnerability such as SVI, rather than race, in disparities research.