我们试图定义特权与访问敏感的手术条件的计划外手术率和围手术期结果之间的关联。健康的社会决定因素 (SDOH) 对于影响及时获得医疗保健至关重要。特权代表对所有 SDOH 产生积极影响的权利、利益、优势或机会。加州卫生保健获取和信息部 (HCAI) 数据库确定了 2017 年期间接受腹主动脉瘤修复术、腹疝修复术或结肠癌结肠切除术的患者和 2020 年，并使用邮政编码与极端集中指数合并，这是从美国社区调查中获得的种族和经济特权的有效衡量标准。进行聚类多变量回归来评估特权与结果之间的关联。在 185,316 名因三种手术敏感情况之一接受外科手术的患者中，大约五分之一的人居住在特权最高的地区（Q5；n=37,308； 20.1%）或最低（Q1；n=36,352, 19.6%）特权。近一半的手术是计划外的（n=88,814，46.9%），结肠癌的结肠切除术是执行最多的紧急手术。与居住在最高特权地区的患者相比，居住在最低特权地区的患者的计划外手术率更高（Q1；55.4% vs. 39.4%；参照：Q5；调整后比值比 [OR]，1.23，95%CI 1.16-1.31 P<0.001）。对于每种对手术途径敏感的手术条件，最贫困地区的患者更有可能经历较高的住院死亡率（Q1；3.1% vs. 2.1%；参照：Q5；调整后 OR，1.41，95%CI 1.24-1.60； P<0.001）、围手术期并发症（Q1；30.4% vs. Q5；23.8%；参照：Q5；调整后 OR，1.24，95%CI 1.18-1.31；P<0.001）和延长住院时间（Q1；26.3% vs. 20.1%；参考值：Q5；调整后 OR，1.16，95%CI 1.09-1.22；P<0.001）。特权与计划外手术和不良临床结果相关。这表明作为关键 SDOH 的角色特权会影响患者获得手术护理的机会和质量。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

We sought to define the association of privilege on rates of unplanned surgery and perioperative outcomes for access-sensitive surgical conditions.Social determinants of health (SDOH) are critical in influencing timely access to healthcare. Privilege represents a right, benefit, advantage, or opportunity that positively influences all SDOH.The California Department of Health Care Access and Information (HCAI) database identified patients who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2017 and 2020 and was merged using ZIP codes with the Index of Concentration of Extremes, a validated measure of racial and economic privilege obtained from the American Community Survey. Clustered multivariable regression was performed to assess the association between privilege and outcomes.Among 185,316 patients who underwent a surgical procedure for one of three access-sensitive surgical conditions, roughly 1 in 5 individuals resided in areas with the highest (Q5; n=37,308; 20.1%) or lowest (Q1; n=36,352, 19.6%) privilege. Nearly one-half of the surgeries were unplanned (n=88,814, 46.9%), and colectomy for colon cancer was the most performed emergent procedure. Patients residing in the lowest privileged areas had higher rates of unplanned surgery compared with those residing in the highest privilege (Q1; 55.4% vs. 39.4%; referent: Q5; adjusted odds ratio [OR], 1.23, 95%CI 1.16-1.31; P<0.001). For each access-sensitive surgical condition, patients in the least privileged areas were more likely to experience higher rates of inpatient mortality (Q1; 3.1% vs. 2.1%; referent: Q5; adjusted OR, 1.41, 95%CI 1.24-1.60; P<0.001), perioperative complications (Q1; 30.4% vs. Q5; 23.8%; referent: Q5; adjusted OR, 1.24, 95%CI 1.18-1.31; P<0.001) and extended hospital stays (Q1; 26.3% vs. 20.1%; referent: Q5; adjusted OR, 1.16, 95%CI 1.09-1.22; P<0.001).Privilege was associated with rates of unplanned surgery and adverse clinical outcomes. This indicates the role privilege as a key SDOH that influences patient access to and quality of surgical care.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.