Social determinants of health associated with urgent versus elective cholecystectomy
Sara Myers, MD, Crisanto Torres, MD, MPH, Lisa Allee, Tracey Dechert, MD, Tejal Brahmbhatt, MD, Sabrina Sanchez, MD, MPH
Boston Medical Center, Boston MA
Background: Benign gallbladder disease being (BGD) is the most frequent indication for cholecystectomy in the United States. However, many patients present with complicated disease requiring urgent interventions with increasing morbidity and mortality. We sought to investigate the association of individual and population-based social determinants of health on acute versus elective presentation of BGD.
Methods: All patients undergoing elective (EC), urgent (UC), and delayed (DC) cholecystectomy at our urban, safety-net hospital (2014-2021) for BGD were included (N=3197). Patient demographic and clinical data from the EMR was linked to population-level socioeconomic characteristics using census tracts. Descriptive and inferential statistics were used to analyze the data.
Results: The demographic, clinical, and population-level socioeconomic characteristics of our cohort are summarized in Table 1. In multinomial logistic regression we found that patients who were older (RRR=1.01,p=0.040), male (RRR=0.64,p<0.001), Black (RRR=1.6,p=0.008), and Hispanic (RRR=1.58,p=0.022) had a higher relative risk of presenting with UC. Patients who primarily spoke Spanish (RRR=0.48,p<0.001) or Portuguese (RRR=0.23,p<0.001), had a primary care provider (PCP) (RRR=0.73,p=0.007), and lived in census tracts with a higher percentage of internet access (RRR=0.97, p=0.002) had a lower relative risk of presenting with UC.
Conclusion: Of the multiple variables we evaluated, race/ethnicity, primary language spoken, and having a designated PCP were most significantly associated with presentation with UC vs EC. This highlights the important role of PCPs in early identification and management of BGD.
Back to 2022 Display Posters