Social, Demographic, and Behavioral Determinants of Prolonged Hospital Stay and Readmissions of Postoperative Complications in an Urban Acute Care Hospital

Abstract

Background and Hypothesis The correlation between postoperative complications and social determinants of health (SDOH) is a prominent focus in medical literature due to its implications for healthcare quality and hospital outcomes. In evaluating hospital performance, extended hospital stays (LOS) and readmissions (RA) are critical indicators, prompting initiatives like the Hospital Readmission Reduction Program. Despite efforts, disparities affecting surgical outcomes among urban patients remain underexplored. This study aims to investigate how SDOH influence readmissions and prolonged hospital stays among urban patients experiencing postoperative complications. Conducted through a Community-Based Participatory Research (CBPR) collaboration between Indiana University School of Medicine (IUSM) and Power Health in Northwest Indiana, the research addresses gaps in understanding healthcare disparities in urban settings.

Methods This retrospective study analyzed a dataset sourced from SMMC via EPIC™, focusing on SDOH, demographic profiles, health behaviors, and outcomes of adult inpatients who experienced prolonged hospital stays or 30-day readmissions after surgical procedures at an urban hospital between January 2021 and April 2024. Data analysis utilized SPSS 29.0, employing methods like frequency analysis, Chi-Square tests (p<0.05), binary logistic regression (p<0.05), and linear logistic regression (p<0.05) tailored to the study population. The study received exemption from the Indiana University Human Research Protection Program (IRB # 14040) on 1/28/2022.

Results The study included data from over 900 patients, with 565 readmissions (RA) and 337 extended LOS cases, primarily adults over 50 years old (81.8% RA, 81.4% LOS), White (69.4% RA, 86.3% LOS), and publicly-insured (74.8% RA, 74.7% LOS). Bivariate analysis revealed significant associations between postoperative complications and age (p < 0.001 for RA, p < 0.011 for LOS), veteran status (p = 0.022 for RA, p = 0.058 for LOS), insurance type (p < 0.001 for RA), smoking tobacco use (p < 0.001 for RA, p = 0.026 for LOS), and BMI (p = 0.002 for RA). Multivariate analysis showed that former smoking (OR = 2.144, p < 0.001), underweight BMI (OR = 4.131, p = 0.006), and publicly-insured status (OR = 3.295, p < 0.001) remained significant across all readmission durations. Specifically for 30-day readmission, public insurance (OR = 2.844, p = 0.021) and former smoking (OR = 1.875, p = 0.037) were significant factors.

Potential Impact This research highlights various SDOH and health behaviors associated with increased risks of prolonged hospital stays and readmissions following postoperative complications among urban patients. Policy interventions addressing these factors before and after surgery could potentially mitigate readmissions and extended hospital stays due to procedural complications, thereby improving healthcare outcomes and reducing disparities in urban healthcare settings.