Surgical risks and care trends: A cross sectional study of people experiencing homelessness presenting at a free clinic care in Miami-Dade County

Abstract

Background

The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.

Methods

Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.

Results

Of 300 participants, 18 % (N = 55) had a history of surgery, most common being 1) orthopedics (N = 20), 2) vascular (N = 18), 3) general (N = 6), 4) acute trauma response (N = 5), 5) ophthalmology (N = 4), 6) surgical oncology (N = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, n = 300)=10.9, p < 0.001] and Type II Diabetes [X2 (1, n = 300)=10.5, p = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.

Conclusion

Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.