• Angela Jerath, Peter C Austin, Dennis T Ko, Harindra C Wijeysundera, Stephen Fremes, Daniel McCormack, and Duminda N Wijeysundera.
• From the Department of Anesthesia (A.J.) Division of Cardiology (D.T.K., H.C.W.) Division of Cardiac Surgery (S.F.) Sunnybrook Research Institute (A.J., P.C.A., D.T.K., H.C.W., S.F.), Sunnybrook Health Sciences Centre, Toronto, Canada Department of Anesthesia, University of Toronto, Toronto, Canada (A.J., D.N.W.) Institute of Clinical Evaluative Sciences (ICES), Toronto, Canada (A.J., P.C.A., D.T.K., H.C.W., S.F., D.M., D.N.W.) Toronto General Hospital Research Institute, Toronto, Canada (A.J.) Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada (D.N.W.).
• Anesthesiology. 2020 Apr 1; 132 (4): 713-722.

BackgroundSocioeconomic status is an important but understudied determinant of preoperative health status and postoperative outcomes. Previous work has focused on the impact of socioeconomic status on mortality, hospital stay, or complications. However, individuals with low socioeconomic status are also likely to have fewer supports to facilitate them remaining at home after hospital discharge. Thus, such patients may be less likely to return home over the short and intermediate term after major surgery. The newly validated outcome, days alive and out of hospital, may be highly suited to evaluating the impact of socioeconomic status on this postdischarge period. The study aimed to determine the association of socioeconomic status with short and intermediate term postoperative recovery as measured by days alive and out of hospital.MethodsThe authors evaluated data from 724,459 adult patients who had one of 13 elective major noncardiac surgical procedures between 2006 and 2017. Socioeconomic status was measured by median neighborhood household income (categorized into quintiles). Primary outcome was days alive and out of hospital at 30 days, while secondary outcomes included days alive and out of hospital at 90 and 180 days, and 30-day mortality.ResultsCompared to the highest income quintile, individuals in the lowest quintile had higher unadjusted risks of postoperative complications (6,049 of 121,099 [5%] vs. 6,216 of 160,495 [3.9%]) and 30-day mortality (731 of 121,099 [0.6%] vs. 701 of 160,495 [0.4%]) and longer mean postoperative length of stay (4.9 vs. 4.4 days). From lowest to highest income quintile, the mean adjusted days alive and out of hospital at 30 days after surgery varied between 24.5 to 24.9 days.ConclusionsLow socioeconomic status is associated with fewer days alive and out of hospital after surgery. Further research is needed to examine the underlying mechanisms and develop posthospital interventions to improve postoperative recovery in patients with fewer socioeconomic resources.

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