Abstract
Background
A growing body of work has considered the significance of patients’ psychosocial support and surrounding socioeconomic milieu on surgical outcomes. The presence of such psychosocial risk factors (PSRFs) may define both access to and engagement with care, particularly for access-sensitive conditions, such as colon resection. Yet, the impact of PSRF on outcomes following colectomy remains to be delineated.
Methods
We queried the Nationwide Readmissions Database for all adults undergoing elective/emergent colectomy for benign neoplasms, colon cancer, diverticular disease, or inflammatory bowel disease from 2016 to 2022. The presence of PSRF across 5 domains (low-income or uninsured status, substance use, psychiatric disease, and cognitive limitations) was identified using validated administrative codes. Patients with ≥1 PSRF comprised the At-Risk cohort (others: Not-At-Risk).
Results
Among ∼1,130,803 records, 497,336 (44.0%) had ≥1 documented PSRF. The At-Risk cohort was younger and of greater comorbidity burden, and more frequently underwent open resection at non-metropolitan centers. Following comprehensive risk adjustment, the presence of PSRF remained associated with greater likelihood of in-hospital mortality (AOR 1.17, CI 1.11-1.22) and any major complication (AOR 1.09, CI 1.07-1.11), as well as non-home discharge (AOR 1.41, CI 1.37-1.44) and non-elective readmission within 30 days (AOR 1.10, CI 1.08-1.12). These associations persisted when evaluating only patients treated at high colectomy volume hospitals.
Discussion
In this national study, the presence of PSRF was associated with significantly inferior outcomes following colectomy. Notably, this association was not mitigated by care at high volume hospitals. Psychosocial risk factors should be considered as part of risk stratification and care optimization efforts across institutions.
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