Researchers used the Neighborhood Deprivation Index (NDI) to assess the relationship of socioeconomic status to OSA surgery. NDI is a more granular approach than using ZIP codes, factoring in 13 variables in the categories of wealth and income, education, occupation, and housing conditions, Dr. Block-Wheeler said.
Explore This IssueAugust 2023
Compared to the least deprived NDI quartile, those in the most deprived quartile were 16% less likely to receive surgery, while those in the second- and third-most deprived quartiles were 20% and 23% less likely to receive surgery, respectively.
Those on Medicaid or state-subsidized insurance were 43% less likely to receive surgery compared to those with other insurance types, researchers found.
The findings based on NDI also indicate access problems, he said. In the analysis of race and ethnicity, the groups compared were non-Hispanic White, Black, Asian/Pacific Islander, Hispanic, and Other/Unknown. Dr. Block-Wheeler emphasized that these were opt-in categories that were predefined. Those identifying as Black were 12% less likely than Whites to undergo surgery, Asian/Pacific Islander 17% less likely, and Hispanics 18% more likely, researchers reported.
Researchers also looked at marital status, which Dr. Block-Wheeler said was “an interesting category.” Those who were single were 13% less likely to receive surgery than those who were married, but those who were separated or divorced were 45% more likely. Dr. Block-Wheeler suggested that those separated or divorced might have been diagnosed at the behest of their prior partner, and then the patient pursued surgical treatment once the relationship ended.
“Future work,” Dr. Block-Wheeler said, “will begin to look at changes over time and investigate drivers of these differences.”
Family Assistance Predictive of Discharge Location After Free Flaps
A lack of family assistance was the top predictor of whether a patient undergoing free flap reconstruction needed inpatient rehabilitation after the surgery, according to a recent analysis.
“Discharge disposition can be unpredictable, with recovery sometimes changing baseline functional status,” said Megha Chandna, BS, an otolaryngology research fellow at Thomas Jefferson University in Philadelphia. “We believe that this is important because home discharge after surgery has been described as a performance metric at a variety of hospitals, and other studies have found a relationship of discharge disposition with functional abilities at admission,” including walking, basic activities of daily living, and cognition, as well as with age, gender, BMI, and comorbidities.
Researchers examined all elective admissions for head and neck free flap reconstruction at Jefferson between January 2017 and November 2022. The patients all had a postoperative evaluation by physical therapy and occupational therapy. The researchers looked only at whether a patient was discharged to their home or to inpatient rehabilitation. Of the 544 patients whose cases were assessed, 20.3% were discharged to inpatient rehab and 79.7% to home. Neoplasm was the most common indication for the procedure, and an anterolateral thigh free flap was the most common type of procedure.