Lusby, Eimear;
Wong, Danny JN;
Campbell, Ruaraidh;
Hou, Bo;
Pereira, Snehal Pinto;
Harris, Steve K;
Moonesinghe, S Ramani;
(2025)
Social deprivation and morbidity and mortality after surgery: a UK national observational cohort study.
British Journal of Anaesthesia
10.1016/j.bja.2025.07.058.
(In press).
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Abstract
Background: Socioeconomic deprivation is associated with poor surgical outcomes. We assessed associations between deprivation and postoperative morbidity and mortality in a UK-wide surgical cohort. Methods: We analysed UK data from the Second Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS), a prospective non-consenting cohort study of adults undergoing elective and emergency inpatient noncardiac surgery. Socioeconomic deprivation was reported using the standardised aggregate scale, Index of Multiple Deprivation (IMD; IMD1: most deprived, IMD5: least deprived). Multivariable mixed effects logistic regression was used to model the association between deprivation and postoperative outcomes, adjusting for potential confounders. Results: Of the 18 901 patients included, those in more deprived groups were younger, had higher disease prevalence, and had greater illness severity. Morbidity, as measured by the Post-Operative Morbidity Survey, was reported in 13.7% at day 7, and in-hospital 30-day mortality was 1.3%. Adjusting for patient characteristics and surgical factors, the odds ratios (ORs) for morbidity at day 7 were 1.26 (95% confidence interval [95% CI]: 1.09–1.47) for IMD2 and 1.32 (95% CI: 1.13–1.53) for IMD1, compared with IMD5. Mortality risk was also higher: OR 1.75 (95% CI: 1.12–1.73) for IMD2 and OR 1.90 (95% CI: 1.22–2.95) for IMD1. However, after adjusting for markers of preoperative physical status and comorbidities, the association between deprivation and outcomes was attenuated. Conclusions: Socioeconomic deprivation is associated with short-term postoperative morbidity and mortality. This association might relate to poorer baseline fitness among people living in socioeconomically deprived areas, highlighting opportunities for targeted preoperative optimisation.
| Type: | Article |
|---|---|
| Title: | Social deprivation and morbidity and mortality after surgery: a UK national observational cohort study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.bja.2025.07.058 |
| Publisher version: | https://doi.org/10.1016/j.bja.2025.07.058 |
| Language: | English |
| Additional information: | Crown Copyright © 2025 Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | healthcare disparities, morbidity, perioperative care, postoperative complications, socioeconomic factors, surgery |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10214541 |
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