De Jager, Elzerie, Gunnarsson, Ronny, and Ho, Yik-hong (2022) Emergency to elective surgery ratio as a disparities sensitive surgical access metric, a study of low socioeconomic status in Australia. World Journal of Surgery, 46. pp. 776-783.

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Abstract

Background

The emergency to elective surgery ratio is a proposed indicator for global access to surgical care. There is a well-established link between low socioeconomic status and increased morbidity and mortality. This study examined the emergency to elective surgery ratios for low socioeconomic patients utilising both self-reported unemployment and the neighbourhood Index of Economic Resources (IER).

Methods

A retrospective study was conducted at a regional tertiary care centre in Australia, including data over a ten-year period (2008–2018). Multivariable logistic regression adjusting for year, age, sex, Charlson Comorbidity Index, rurality, and if surgeries were due to trauma or injuries, was performed.

Results

84,014 patients underwent a surgical procedure in the period examined; 29.0% underwent emergency surgery, 5.31% were unemployed, and 26.6% lived in neighbourhoods with the lowest IER. Following multivariable testing, the rate of emergency surgery was higher for unemployed patients (OR 1.42 [1.32–1.52], p < 0.001), and for those from the lowest IER (OR 1.13 [1.08–1.19], p < 0.001). For unemployed patients, this disparity increased during the study period (OR 1.32 [2008–2012], OR 1.48 [2013–2018]). When stratified by specialty, most (7/11) had significant disparities for unemployed patients: Cardiac/Cardiothoracic, Otolaryngology, Maxillofacial/Dental, Obstetrics/Gynaecology, Orthopaedics, Plastics, and Vascular surgery.

Conclusions

Unemployed Australians and those residing in the most disadvantaged IER neighbourhoods had higher emergency to elective surgery rates. The disparity in emergency to elective surgery rates for unemployed patients was found in most surgical specialties and increased over the period examined. This suggests a widespread and potentially increasing disparity in access to surgical care for patients of socioeconomic disadvantage, specifically for those who are unemployed.

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