A national analysis of social drivers of health and post-operative outcomes in previously healthy children

INTRODUCTION: To better understand the relationships between social drivers of health (SDoH) and pediatric surgical outcomes, we examined neighborhood-based SDoH and surgical outcomes in a national cohort of children with low baseline surgical risk.

METHODS: Multicenter, retrospective cohort study of healthy (American Society of Anesthesiologists Class I and II) children <18 years old undergoing surgery at 8 National Surgical Quality Improvement Program-Pediatric hospitals (1/1/2016-12/31/2021). We investigated associations between three validated SDoH indices [Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)] and serious postoperative complication; presentation to the emergency department (ED) for surgical care; hospital length of stay (LOS); and surgical site infection (SSI). All indices were re-scaled to present decile change for analysis. Multivariable regression models controlled for age, sex, racialization, pre-operative comorbidities, and hospital proximity (fixed effects) and hospital site (random effect).

RESULTS: 38,514 healthy children underwent surgical procedures during the study period. We found significant associations between increasing deciles of both COI and SVI and odds of ED admission (COI: OR 1.018, 95% CI 1.008-1.027, p<0.001; SVI: OR 1.022, 95% CI 1.013-1.031, p<0.001). While no significant associations were found between any SDoH index and SSI or serious complications, increased LOS was associated with both ADI (IRR 1.011, 95% CI 1.004-1.017, p<0.001) and COI (IRR 1.009, 95% CI 1.004-1.015, p<0.001).

CONCLUSION: Children from more disadvantaged neighborhoods more frequently present through the ED preoperatively and experience longer LOS. Future work should investigate the potential drivers of these disparities in access and healthcare utilization.