Identifying Social Determinants of Health Associated with Same-Day Cancellations for Urologic Surgery.

IF 2.1 3区 医学 Q2 UROLOGY & NEPHROLOGY Urology Pub Date : 2025-03-12 DOI:10.1016/j.urology.2025.03.005
Lynn Leng, Pablo A Suarez, Mubarak A Momodu, Sudarshan Srirangapatanam, David B Bayne
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Abstract

Objective: To identify upstream factors associated with unplanned urologic surgery cancellations at a safety-net hospital.

Methods: A retrospective cohort study of patients (age >18) scheduled for urologic surgery operating room procedures between January 2021 and June 2023 at an urban county hospital was conducted. Patient demographics, social determinants of health, and clinical data were abstracted from electronic health records. The primary outcome was unplanned day-of-surgery cancellations. Continuous and categorical variables were analyzed using Mann-Whitney and chi-square, respectively. A multivariable logistic regression model was used to assess the effect of variables on predicting cancellations.

Results: Out of 778 patients, 136 (17.5%) had a day-of-surgery cancellation. Multivariable model revealed wheelchair use (OR 3.17 [1.78,5.63], p<0.001), Black race (OR 2.62 [1.38,4.98], p=0.003), history of incarceration (OR 2.00 [1.04,3.83], p=0.037, higher rates of prior missed appointments (OR 1.02 [1.00,1.04], p=0.047), and assigned primary care provider (OR 0.58 [0.37,0.89], p=0.014) as statistically significant.

Conclusions: Day-of-surgery cancellations negatively affect patient outcomes, disrupt hospital workflow, and increase care costs. This study is the first to examine a more comprehensive list of patient-specific factors in relation to day-of-surgery cancellations. By providing further insight into factors associated with cancellations, our findings set the stage for targeted interventions to improve healthcare quality and equity for patients' access to urologic surgery.

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摘要确定与一家安全网医院泌尿外科手术意外取消相关的上游因素:对一家城市县级医院 2021 年 1 月至 2023 年 6 月期间计划在手术室进行泌尿外科手术的患者(年龄大于 18 岁)进行了一项回顾性队列研究。研究人员从电子健康记录中抽取了患者的人口统计学特征、健康的社会决定因素和临床数据。主要结果是手术当天计划外取消手术。连续变量和分类变量分别采用 Mann-Whitney 和卡方进行分析。采用多变量逻辑回归模型评估变量对预测取消手术的影响:在778名患者中,有136人(17.5%)在手术当天取消了手术。多变量模型显示,使用轮椅(OR 3.17 [1.78,5.63], p结论:手术当日取消会对患者预后产生负面影响,扰乱医院工作流程,增加护理成本。本研究首次更全面地研究了与手术当天取消相关的患者特异性因素。通过进一步了解与取消手术相关的因素,我们的研究结果为采取有针对性的干预措施以提高医疗质量和患者接受泌尿外科手术的公平性奠定了基础。
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来源期刊
Urology
Urology 医学-泌尿学与肾脏学
CiteScore
3.30
自引率
9.50%
发文量
716
审稿时长
59 days
期刊介绍: Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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