Social deprivation and morbidity and mortality after surgery: a UK national observational cohort study

Abstract

Background: Socioeconomic deprivation is associated with poor surgical outcomes. We assessed associations between deprivation and postoperative morbidity and mortality in a UK-wide surgical cohort.

Methods: We analysed UK data from the Second Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS), a prospective non-consenting cohort study of adults undergoing elective and emergency inpatient noncardiac surgery. Socioeconomic deprivation was reported using the standardised aggregate scale, Index of Multiple Deprivation (IMD; IMD1: most deprived, IMD5: least deprived). Multivariable mixed effects logistic regression was used to model the association between deprivation and postoperative outcomes, adjusting for potential confounders.

Results: Of the 18 901 patients included, those in more deprived groups were younger, had higher disease prevalence, and had greater illness severity. Morbidity, as measured by the Post-Operative Morbidity Survey, was reported in 13.7% at day 7, and in-hospital 30-day mortality was 1.3%. Adjusting for patient characteristics and surgical factors, the odds ratios (ORs) for morbidity at day 7 were 1.26 (95% confidence interval [95% CI]: 1.09-1.47) for IMD2 and 1.32 (95% CI: 1.13-1.53) for IMD1, compared with IMD5. Mortality risk was also higher: OR 1.75 (95% CI: 1.12-1.73) for IMD2 and OR 1.90 (95% CI: 1.22-2.95) for IMD1. However, after adjusting for markers of preoperative physical status and comorbidities, the association between deprivation and outcomes was attenuated.

Conclusions: Socioeconomic deprivation is associated with short-term postoperative morbidity and mortality. This association might relate to poorer baseline fitness among people living in socioeconomically deprived areas, highlighting opportunities for targeted preoperative optimisation.

Keywords: healthcare disparities; morbidity; perioperative care; postoperative complications; socioeconomic factors; surgery.