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. 2023 Apr 28:13:100167.
doi: 10.1016/j.sipas.2023.100167. eCollection 2023 Jun.

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

Jorge G Zarate Rodriguez  1 , William C Chapman Jr  1 , Dominic E Sanford  1 , Chet W Hammill  1 , Paul E Wise  1 , Radhika K Smith  1 , Sean C Glasgow  1 , Matthew L Silviera  1
Affiliations

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

Jorge G Zarate Rodriguez et al. Surg Pract Sci. .

Abstract

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.

Keywords: Diverticulitis; Healthcare disparities; Social vulnerability; Stoma.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Multivariable logistic regression model for stoma creation among patients undergoing urgent/emergent colectomy for uncomplicated diverticulitis. (MIS: minimally invasive surgery).
See this image and copyright information in PMC

References

    1. Tsai T.C., Orav E.J., Joynt K.E. Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care. Ann Surg. 2014;259(6):1086–1090. - PMC - PubMed
    1. Zarate Rodriguez J.G., Cos H., Williams G.A., et al. Inability to manage non-severe complications on an outpatient basis increases non-white patient readmission rates after pancreaticoduodenectomy: a large metropolitan tertiary care center experience. Am J Surg. 2021;222(5):964–968. - PubMed
    1. Murphy M.M., Simons J.P., Ng S.C., et al. Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16(11):2968–2977. - PubMed
    1. Hall J., Hardiman K., Lee S., et al. The american society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;63(6):728–747. - PubMed
    1. Maurer L.R., Allar B.G., Perez N.P., et al. Non-english primary language is associated with emergency surgery for diverticulitis. J Surg Res. 2021;268:643–649. - PubMed

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