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Martin SR, Kain ZN. The intersection of pediatric anesthesiology and social determinants of health. Curr Opin Anaesthesiol 2024; 37:271-276. [PMID: 38441068 PMCID: PMC11042989 DOI: 10.1097/aco.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE OF REVIEW There is increasing evidence of racial and ethnic disparities in pediatric perioperative care, which indicates a need to identify factors driving disparities. Social determinants of health (SDOH) play a fundamental role in pediatric health and are recognized as key underlying mechanisms of healthcare inequities. This article summarizes recent research exploring the influence of SDOH on pediatric perioperative outcomes. RECENT FINDINGS Despite the scarcity of research exploring SDOH and pediatric perioperative outcomes, recent work demonstrates an association between SDOH and multiple outcomes across the perioperative care continuum. Measures of social disadvantage were associated with preoperative symptom severity, longer hospital stays, and higher rates of postoperative complications and mortality. In some studies, these adverse effects of social disadvantage persisted even when controlling for medical comorbidities and clinical severity. SUMMARY The existing literature offers compelling evidence of the impact of SDOH on perioperative outcomes in children and reveals a critical area in pediatric anesthesia that necessitates further exploration and action. To improve outcomes and address care inequities, future efforts should prioritize the integration of SDOH assessment into pediatric perioperative research and practice.
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Affiliation(s)
- Sarah R. Martin
- Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Irvine CA
- Center on Stress & Health, University of California Irvine, Irvine, CA
- Emergency Medicine, Children’s Hospital of Orange County, Orange, CA
| | - Zeev N. Kain
- Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Irvine CA
- Center on Stress & Health, University of California Irvine, Irvine, CA
- Yale University Child Study Center, New Haven, Connecticut
- Children’s Hospital of Orange County, Orange, CA
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Midura D, Levano S, Fiori KP, Farber BA. Analysis of Social Determinants of Health in the Pediatric General Surgical Population of a Northeastern Urban Health System. J Pediatr Surg 2024:S0022-3468(24)00294-X. [PMID: 38760308 DOI: 10.1016/j.jpedsurg.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) have been identified as factors that influence patient health outcomes. These are well described in adult and pediatric general populations, however, there is a paucity of data for surgical patients. This study compares the prevalence of health-related social needs (HRSN) among pediatric surgery and general pediatric patients. METHODS We retrospectively assessed electronic health record data to identify patients who completed a standardized HRSN screener within our health system and underwent surgery by a pediatric surgeon between January 2019 and December 2021. We compared this population to non-surgical pediatric patients during this time. Bivariate and multivariate logistic regressions were conducted to estimate the likelihood of having 1 or more HRSN given a patient's surgery status. Logistic and linear regressions were conducted to estimate healthcare utilization in pediatric surgery patients given their HRSN status. RESULTS 33,989 general pediatric and pediatric surgery patients (age <21 years) were screened for HRSNs, and 2112 operations were performed during the study period. 343 (20%) of the surgical patients operated on by pediatric surgeons were screened for HRSNs. Surgical patients were more likely to be younger, Latinx, Spanish-speaking, and non-commercially insured (p < 0.0001). Surgical patients were 50% more likely to report one or more HRSN, when adjusting for demographic characteristics (aOR 1.50, 95% CI 1.16, 1.94). CONCLUSION Pediatric surgery patients are more likely to report HRSNs compared to the general pediatric population. Surgical patients may represent an at-risk group, and universal HRSN screening and support should be considered to improve outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devin Midura
- Department of Surgery, Division of Pediatric Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3355 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Samantha Levano
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA; Department of Family & Social Medicine, Division of Research, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA; Department of Family & Social Medicine, Division of Research, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA; Office of Community & Population Health, Montefiore Health System, 3514 DeKalb Avenue, Bronx, NY, 10467, USA
| | - Benjamin A Farber
- Department of Surgery, Division of Pediatric Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3355 Bainbridge Avenue, Bronx, NY 10467, USA.
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Chacon MA, Cook CA, Flynn-O'Brien K, Zagory JA, Choi PM, Wilson NA. Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature. J Pediatr Surg 2024:S0022-3468(24)00185-4. [PMID: 38631997 DOI: 10.1016/j.jpedsurg.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
CONTEXT Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices. OBJECTIVE We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes. DATA SOURCES A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023). STUDY SELECTION Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric. DATA EXTRACTION Extraction domains included study, patient, and procedure characteristics. RESULTS Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent. LIMITATIONS All studies were retrospective and quality varied from good to fair. CONCLUSIONS While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care. TYPE OF STUDY Systematic Review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Miranda A Chacon
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Caitlin A Cook
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Katherine Flynn-O'Brien
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 8915 W. Connell Ct., Milwaukee, WI 53226, USA
| | - Jessica A Zagory
- Division of Pediatric Surgery, Department of Surgery, Louisiana State University Health Sciences Center - New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Pamela M Choi
- Department of Surgery, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA; Department of Biomedical Engineering, University of Rochester, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA.
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Riggall EA, Slomine BS, Suskauer SJ, Borda A, Lahey S, Ludwig NN. Caregiver and family functioning after pediatric disorder of consciousness: telephone-based outcome assessment. Brain Inj 2024; 38:99-107. [PMID: 38328910 DOI: 10.1080/02699052.2024.2304884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/15/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Examine initial feasibility/utility of a telephone-administered measure in describing impact of child health on caregiver/family functioning in patients with a history of a disorder of consciousness (DoC) due to severe-acquired brain injury (ABI). METHOD Caregivers of patients admitted at least 1 year prior for inpatient rehabilitation with DoC completed a battery of measures administered via telephone examining the impact of child health on caregiver/family functioning (Pediatric Quality of Life Family Impact Module; PedsQL-FIM) and child functioning. RESULTS Forty-one caregivers of unique patients (age = 5-22 years; M = 14.9, SD = 5.1; 63% male; time since injury = 1-18 years; M = 5.3; SD = 4.2) completed the telephone measures. PedsQL-FIM floor and ceiling effects were minimal (administration time = 5-16 min, M = 7.4; SD = 2.8). Family functioning was lowest in Daily Activities and highest in Family Relationships. Relative to caregivers of patients with mild-severe ABI, caregivers reported lower caregiver/family functioning. Correlations were moderate between child functioning and caregiver/family functioning on some PedsQL-FIM scales. CONCLUSIONS Within this relatively small convenience sample, results indicate the PedsQL-FIM administered via telephone is feasible and useful in describing the impact of child health on caregiver/family functioning long after DoC associated with ABI. Future studies are needed to understand factors contributing to caregiver/family functioning to inform targeted interventions.
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Affiliation(s)
- Emily A Riggall
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stacy J Suskauer
- Department of Rehabilitation, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department Physical Medicine and Rehabilitation and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Allison Borda
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Sarah Lahey
- Neuropsychology, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Smith CJ, Raval MV, Simon MA, Henry MCW. Addressing pediatric surgical health inequities through quality improvement efforts. Semin Pediatr Surg 2023; 32:151280. [PMID: 37147217 DOI: 10.1016/j.sempedsurg.2023.151280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Concepts of healthcare quality and health equity should be inextricably linked but are often pursued separately. Quality improvement (QI) can serve as a powerful means to eliminate health inequities by adopting an equity-focused lens to diagnose and address baseline disparities among pediatric populations using targeted interventions. QI and pediatric surgery practitioners should integrate concepts of equity at every stage of formulating a QI project including conceptualization, planning, and execution. Early adaptation of an equity conscious perspective using QI methodology can prevent exacerbation of preexisting disparities while improving overall outcomes.
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Affiliation(s)
- Charesa J Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marion C W Henry
- Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Yap A, Laverde R, Thompson A, Ozgediz D, Ehie O, Mpody C, Vu L. Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California. Am J Surg 2023; 225:122-128. [PMID: 36184328 DOI: 10.1016/j.amjsurg.2022.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/27/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Area-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions. METHODS This retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1-2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015-2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery. RESULTS Among 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.02-2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03-2.98). CONCLUSION Neighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention.
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Affiliation(s)
- Ava Yap
- University of California San Francisco, Department of Surgery, USA.
| | - Ruth Laverde
- University of California San Francisco, School of Medicine, USA
| | - Avery Thompson
- University of California San Francisco, School of Medicine, USA
| | - Doruk Ozgediz
- University of California San Francisco, Department of Surgery, USA
| | | | - Christian Mpody
- Nationwide Children's Hospital, Department of Anesthesiology and Pain Medicine, USA
| | - Lan Vu
- University of California San Francisco, Department of Surgery, USA
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