Association of social determinants of health‐related diagnosis codes with postoperative outcomes
Gwyneth A. Sullivan, Vaishnavi Krishnan, Casey Silver, Charesa Smith, Mehul V. Raval, Brian C. Gulack, Ami N. Shah- Surgery
Abstract
Background
The association of an individual's social determinants of health‐related problems with surgical outcomes has not been well‐characterized. The objective of this study was to determine whether documentation of social determinants of a health‐related diagnosis code (Z code) is associated with postoperative outcomes.
Methods
This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health‐related problems. The primary outcome was 30‐day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30‐day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes.
Results
Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health‐related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39–2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33–1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89–4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45–2.73).
Conclusions
Social determinants of health‐related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health‐related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.