Surgical Outcomes Among Patients Experiencing Homelessness: A Retrospective Observational Cohort Study
Florencia Pereira1, Maia Nofal1, Lucero Paredes1, Javier Galindo1, Megan Janeway MD2, Michael Paulson MD2, Tracey Dechert MD2, Sabrina Sanchez MD2 1Boston University School of Medicine 2Department of Surgery, Boston University Medical Center
Background:
Homelessness is associated with increased overall mortality compared to the general population. Little is known about surgical needs in this population. We aim to examine the independent effects of homelessness on surgical outcomes.
Methods:
We performed a retrospective observational cohort study of homeless and housed patients aged 18 to 89 admitted to surgical services at a tertiary care center from 2014 to 2017. Our primary outcome was postoperative complications. Secondary outcomes included outpatient follow-up, Emergency Department visits, and 30-day unplanned readmissions.
Results:
We included 372 patients (124 homeless, 248 housed). Of those experiencing homelessness, the majority were non-white (52%) and male (77%). Both homeless and housed populations had similar rates of complications (20% and 23%, respectively). 66% of those experiencing homelessness made follow-up appointments, compared to 63% of housed patients. Individuals experiencing homelessness were more likely (19% versus 15%) to visit the ED, although 11.4% had 30-day unplanned readmissions from both cohorts.
Conclusion:
In our cohort, homeless and housed patients had comparable rates of postoperative complications and 30-day unplanned readmissions. However, homeless patients had a higher ED utilization rate despite being more likely to attend their follow up appointments. Homeless individuals have equivalent surgical outcomes as their housed counterparts, however may benefit from closer postoperative follow-up.
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