比较生活在不同社会资本水平的人口普查区的受益人中因访问敏感的外科疾病而进行计划外手术的比率。访问敏感的外科疾病是在选择性环境中进行理想筛查和治疗的疾病。然而，如果不及时治疗，这些情况可能会导致计划外（即紧急或紧急）手术。社会资本（个人通过其社交网络成员资格可获得的资源）可能会影响计划手术发生的可能性。接受过三种访问敏感手术（腹主动脉瘤修复术、癌症结肠切除术）之一的医疗保险受益人和腹疝修复术）在 2016 年至 2020 年之间根据人口普查区的社会资本水平（暴露变量）进行分层。结果包括计划外手术率、再入院率、30 天死亡率和并发症，这些结果通过逻辑回归模型进行了风险调整，该模型考虑了患者年龄、性别、种族、合并症和面积剥夺。总共包括 975,048 名受益人（患者平均年龄 [SD] 76 [7.6] 岁；443,190 名患者为男性 [45.45%]）。与来自总体社会资本最高十分位的人口普查区的患者相比，来自社会资本最低的人口普查区的患者平均更有可能接受计划外手术（40.67% vs 35.28%，OR=1.26 P<0.001）。此外，这些社区的受益人也更有可能出现术后并发症（24.99% vs 22.90%，OR=1.12 P<0.001），但再入院率或死亡率没有显着差异。当仅评估择期手术时，最低和最高社会资本十分位数组之间的并发症差异显着减小（12.77% vs 12.11%，OR=1.06 P=0.04），死亡率差异崩溃，再入院率差异仍然不显着。这些数据表明，居住在社会资本较低社区的医疗保险受益人更有可能因访问敏感的情况而接受计划外手术。努力改善这些社区的社会资本可能是降低计划外手术率的一项策略。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels.Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.e., urgent or emergent) surgery. It is possible that social capital-the resources available to individuals through their membership in a social network-may impact the likelihood of a planned procedure occurring.Medicare beneficiaries who underwent one of three access-sensitive procedures (abdominal aortic aneurysm repair, colectomy for cancer, and ventral hernia repair) between 2016-2020 were stratified by their census tract level of social capital, the exposure variable. Outcomes included rate of unplanned surgery, readmission, 30-day mortality, and complications which were risk-adjusted with a logistic regression model that accounted for patient age, sex, race, comorbidities, and area deprivation.A total of 975,048 beneficiaries were included (mean [SD] patient age, 76 [7.6] years; 443,190 were male [45.45%]). Compared to patients from census tracts in the highest overall social capital decile, those from census tracts with the least social capital were on average more likely to undergo unplanned surgery (40.67% versus 35.28%, OR=1.26 P<0.001). Additionally, beneficiaries in these communities were also more likely to experience postoperative complications (24.99% versus 22.90%, OR=1.12 P<0.001), but there was no significant difference in rates of readmission or mortality. When evaluating only elective procedures, the differences between the lowest and highest social capital decile groups reduced significantly for complications (12.77% versus 12.11%, OR=1.06 P=0.04), the differences in mortality rates collapsed, and differences in readmission rates remained insignificant.These data suggest that Medicare beneficiaries who live in communities with lower social capital are more likely to undergo unplanned surgery for access-sensitive conditions. Efforts to improve social capital in these communities may be one strategy for reducing the rate of unplanned operations.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.