Area Deprivation Index Correlates with a Lower Rate of Hospital Readmission from the Emergency Room following Endoscopic Skull Base Surgery

Background: The area deprivation index (ADI) is a validated measure of socio-geographical disadvantage calculated from United States Census data that has been correlated with a variety of poor medical and surgical outcomes. Healthcare utilization, such as emergency department (ED) visits, and hospital readmission within 30 days of surgery are nationally tracked metrics of healthcare quality. Numerous risk factors have been identified for ED visits and readmission after endoscopic skull base surgery (ESBS). However, ADI has never been studied in the context of postoperative outcomes in ESBS.

Purpose: To assess the relationship between ADI and postoperative outcomes following ESBS, including ED visits and hospital readmissions within 30 days of surgery.

Methods: A retrospective cohort was assembled of all patients who presented to the emergency room within 30 days of ESBS from January 2017 to June 2022. ADI scores were obtained using patient United States home address. Demographic data, medical comorbidities, surgical intervention and pathology, postoperative complications, reason for emergency room visit, and readmission status was gathered. Univariable analyses were performed with a cut-off of p < 0.20 to select variables for logistic regression. Multivariable logistic regression models were compared with the likelihood-ratio test. The best performing model had significance for predictor variables set at p < 0.05.

Results: Out of 559 cases of ESBS, 61 patients (10.9%) presented to the ED within 30 days of ESBS; 37 patients were discharged (6.6%), and 24 patients were readmitted (4.3%). The most common reasons for ED visits in the non-readmitted group were headache (n = 15), epistaxis (n = 7), and nausea/vomiting (n = 5); the most common reasons in the readmitted group were nausea/vomiting (n = 7), rhinorrhea (n = 7), and headache (n = 5). Readmitted patients were significantly older than those who were not readmitted: 63 years versus 47 years, p = 0.002. There were no other significant differences in demographic, medical, or surgical variables between the two groups. Patients who were readmitted had a significantly lower median ADI (i.e., were socio-geographically more advantaged) than those who were not readmitted: readmitted median ADI 38 versus not-readmitted median ADI 78, p < 0.001. A 10-unit increase in ADI was associated with an odds ratio of 0.71 (95% CI: 0.55–0.90) with respect to readmission on multivariable logistic regression.

Conclusions: Less-advantaged patients, as measured by the ADI, were readmitted at a significantly lower rate from the ED following ESBS than more-advantaged patients. This difference may reflect higher ED utilization for minor postoperative concerns by patients with fewer resources and issues with health literacy. The ADI is a nuanced metric of social and regional disadvantage and may have important implications for resource utilization following ESBS. To our knowledge, this study is the first to utilize ADI to investigate patient postoperative outcomes in ESBS. Further research is needed to develop and validate predictive models that consider patient socio-geographical factors, such as ADI. These models can guide healthcare policy to reduce postoperative complications and improve patient outcomes following ESBS.

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Artikel online veröffentlicht:
01. Februar 2023