医疗保险受益人之间的社会资本和手术访问

为了比较生活在不同社会资本水平的人口普查区中的受益人之间的访问敏感手术状况的计划外手术状况的速度。Access敏感的手术条件是在选修环境中对其进行筛查和治疗的条件。但是，如果不进行治疗，这些条件可能会导致计划外（即紧急或紧急）手术。社会资本资源可能通过社交网络中的成员资格可用的资源影响了计划程序发生的可能性。Medicare受益人接受了三种访问敏感程序之一（腹部主动脉瘤，腹部主动脉瘤修复，癌症的结肠修复，癌症修复和腹部修复），在2016年至2020年之间通过其阶层进行了跨越级别的阶层。结局包括计划外手术，再入院，30天死亡率以及风险调整后的逻辑回归模型的并发症，该模型占患者的年龄，性别，性别，种族，合并症和面积剥夺。总共包括975,048名受益人（平均[SD]患者，76岁[7.6] [7.6] [443,43,3,02.90] [44.60]。与人口普查最高的社会资本十分位数的患者相比，社会资本最少的人口普查区的患者平均进行了计划外的手术的可能性更高（40.67％对35.28％，OR = 1.26 p <0.001）。此外，这些社区中的受益人也更有可能遭受术后并发症（24.99％对22.90％，或= 1.12 p <0.001），但是再入院率或死亡率没有显着差异。在仅评估选举程序时，最低和最高社会资本分数群体之间的差异显着降低了并发症的显着降低（12.77％对12.11％和12.11％或= 1.06 p = 0.04），死亡率差异的差异差异，并且在恢复率的差异差异下，这些数据在较低的社会中均具有较低的社交范围。 状况。在这些社区中改善社会资本的努力可能是降低计划外行动率的一种策略。

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.