Association of Socioeconomic Disadvantage With Postoperative Length of Stay.

Background: Socioeconomic factors significantly influence postoperative recovery, which is a crucial consideration in reducing disparities within enhanced recovery after surgery (ERAS) protocols. The Area Deprivation Index (ADI) serves as a validated measure of neighborhood-level socioeconomic disadvantage; however, its association on postoperative length of stay (LOS) remains underexplored.

Methods: This retrospective cohort study analyzed data from October 2016 to May 2022, examining the association between ADI and postoperative LOS among ERAS patients undergoing elective surgery. Addresses were geocoded and assigned ADI scores, categorizing patients into low, medium, and high ADI levels. Logistic regression models, adjusting for covariates such as insurance status and comorbidities, were used to assess the relationship between ADI and extended LOS, defined as above the 75th percentile.

Results: The study included 11,640 patients with a median age of 56. Patients from high ADI neighborhoods had a significantly higher likelihood of extended LOS compared to those from low ADI neighborhoods (odds ratio 1.22; 95% confidence interval 1.10-1.36; P < 0.001), even after adjusting for demographic and clinical factors.

Conclusions: Higher socioeconomic disadvantage, as measured by ADI, is associated with prolonged postoperative hospital stays. These findings highlight the need for targeted interventions to mitigate disparities in surgical outcomes and enhance equity in ERAS protocols.