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Central Surgical Association

49th Annual Meeting

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Association of Hospital Safety-Net Status with In-Hospital Complications Following Pulmonary Resection for Lung Cancer
Sara Sakowitz, Russyan Mabeza, Arjun Verma, Joseph Hadaya, Yas Sanaiha, Vishal Dobaria, Nam Yong Cho, *Peyman Benharash
Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States

Objective:
Prior studies have demonstrated socioeconomic status to be linked with inferior outcomes following pulmonary lobectomy. Safety-net hospitals (SNH), defined as centers that care for a large proportion of un/underinsured patients, have similarly been associated with worse outcomes. However, studies examining the relationship between SNH status and outcomes of pulmonary lobectomy are lacking. The present national study characterized the impact of SNH on mortality, complications, and overall resource use following elective lobectomy for lung cancer.

Methods:
All adults undergoing elective pulmonary lobectomy for lung cancer were identified using the 2010-2019 Nationwide Readmissions Database. Hospitals in the highest quartile of safety-net burden were categorized as SNH, while others were considered Non-SNH. Multivariable regression models were developed to assess the independent association between safety-net status and in-hospital mortality, infectious, intraoperative, stroke, cardiac, thrombotic, acute kidney injury-related, and respiratory complications, as well as need for blood transfusion, length of stay, hospitalization costs, and non-elective readmission. Intraoperative complications included accidental puncture, hemorrhage, and nerve injury. All complications were further categorized in an ‘any complication’ group.

Results:
Of an estimated 287,000 patients meeting study criteria, 41,101 (14%) were treated at SNH. Patients at SNH were younger, equally likely to be female, and had a lower Elixhauser Comorbidity Index (Table). There was no significant difference in operative approach. Following multivariable adjustment, SNH was associated with higher odds of infectious (AOR 1.26, 95% CI 1.10-1.45), intraoperative (AOR 1.16, 95% CI 1.02-1.32), stroke (AOR 1.35, 95% CI 1.04-1.74), respiratory (AOR 1.09, 95% CI 1.03-1.17) and overall (AOR 1.09, 95% CI 1.03-1.15) complications. Patients at SNH demonstrated greater need for a blood transfusion (AOR 1.21, 95% CI 1.08-1.36). In addition, SNH was associated with reduced LOS (-0.40 days, 95% CI 0.25-0.56) but increased costs (+$3488, 95% CI 2680.86-4295.70), with Non-SNH as reference.

Conclusions:
The present study found that hospital safety-net status was associated with higher odds of perioperative complications after elective lobectomy for lung cancer. Further, despite experiencing a significantly shorter length of stay, patients at SNH incurred greater healthcare costs overall. These findings suggest that safety-net burden should be considered as an institution-level factor that can negatively influence lobectomy outcomes. Considering that safety-net hospitals treat some of society’s most vulnerable people, more work needs to be done to uncover the mechanisms contributing to these complications, eradicate continuing disparities and improve patient outcomes at these institutions.

Figure 1: Association of Safety Net Status on Outcomes of Interest (Reference = Non-Safety Net Hospitals)

Table 1: Patient and Operative Characteristics at SNH Versus Non-SNH


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