Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis

Abstract

Aims

The aim was to determine the effect of socioeconomic deprivation on operative mortality after emergency laparotomy.

Methods

A PRISMA-compliant systematic review and meta-analysis (random-effects modeling) was performed searching for studies comparing operative mortality between the least and the most socioeconomically deprived patients undergoing emergency laparotomy. Both unadjusted and adjusted odds ratio (OR) were calculated as summary measure. Risk of bias was assessed using the Quality In Prognosis Studies tool, and certainty of evidence was assessed using the GRADE system.

Results

Four studies comprising 87,690 patients were included. There was no difference in the risk of operative mortality between the most and least deprived groups (unadjusted OR: 1.57, 95% CI .92, 2.68, P = .100) and when adjusted for other predictors (adjusted OR: 1.11, 95% CI .93, 1.32, P = .230). Subgroup analysis showed consistency of the findings in the United Kingdom (unadjusted OR: 1.36, 95% CI .92, 2.01, P = .130; adjusted OR: 1.15, 95% CI .92, 1.43, P = .230) and in the United States (unadjusted OR: 1.75, 95% CI .75, 4.06, P = .190; adjusted OR: 1.01, 95% CI .79, 1.29, P = .940). Sensitivity analyses showed inconsistency in favor of higher mortality risk in the most deprived patients. The GRADE certainty was moderate.

Conclusions

Socioeconomic deprivation may have minor effect on operative mortality after emergency laparotomy; however, such effect fades away once adjusted for other predictors of mortality. Although independent research is required, it may be reasonable to predict that incorporation of socioeconomic deprivation into preoperative risk assessment tools may not improve their predictive performance.