Work Package 1
Building on our previous work we look at different ways of defining socioeconomic deprivation, and how deprivation and other risk factors such as activity levels and long-term conditions, are linked to outcomes which are important to patients. This information feeds into developing the interventions which are likely to make a difference.
Analysis of two existing datasets
1. SNAP2: EPICCS study (Sprint National Anaesthesia Project 2: Epidemiology of Critical Care after Surgery). This enabled us to evaluate the associations between different measures of socioeconomic position (SEP), and whether their effects are modified by other intersecting preoperative risk factors, and different perioperative processes and outcomes.
2. Perioperative Quality Improvement Programme, PQIP (www.pqip.org.uk)- an ongoing cohort study which has recruited patients in over 160 hospitals in England, Wales and Scotland. PQIP evaluates the relationship between processes and clinical outcomes in patients undergoing major elective surgery, and evaluates risk factors for poor outcomes, with the aim of using data to improve compliance with evidence-based processes. PQIP is nearly at its target sample size of 70,000 participants, and provides a rich source of data for analysis of care and outcome from major non-cardiac surgery.
Social deprivation and morbidity and mortality after surgery: a UK national observational cohort study
We analysed data on 18, 901 patients who had either elective or emergency surgery during a week in 2017, to understand whether area-level socioeconomic position (according to the Index of Multiple Deprivation) was associated with postoperative morbidity (measured using the Post-Operative Morbidity Survey on day 7) or inpatient mortality.
We found that patients living in more deprived areas were younger, had higher disease prevalence, and had greater illness severity. Postoperative morbidity occurred in 13.7% of patients, and inpatient mortality was 1.5%. Patients living in areas of socioeconomic deprivation were more likely to have postoperative morbidity (odds of morbidity increased by 32% for those in the most deprived areas compared with the least deprived) Mortality risk was 90% higher in the more deprived areas than the least. However, after adjusting for markers of preoperative physical status and comorbidities, the association between deprivation and outcomes disappeared.
These findings suggest that while patients living in poorer areas are more likely to have bad surgical outcomes, the difference is most likely due to differences in their preoperative health and fitness. This therefore presents an opportunity to improve these outcomes and narrow this inequality. This supports what we are trying to do in the HIPPOCRATES programme.