Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes
Chad A. Nieri BSCHM
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Search for more papers by this authorCamron Davies MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Search for more papers by this authorJordan B. Luttrell MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Search for more papers by this authorCorresponding Author
Anthony Sheyn MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Division of Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, U.S.A.
Send correspondence to Anthony Sheyn, MD, Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue Suite 430, Memphis, TN 38163.
Email: [email protected]
Search for more papers by this authorChad A. Nieri BSCHM
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Search for more papers by this authorCamron Davies MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Search for more papers by this authorJordan B. Luttrell MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Search for more papers by this authorCorresponding Author
Anthony Sheyn MD
Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Division of Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, U.S.A.
Send correspondence to Anthony Sheyn, MD, Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue Suite 430, Memphis, TN 38163.
Email: [email protected]
Search for more papers by this authorThis article was presented as a podium presentation at the 2023 Triological Society Combined Sections Meeting at Coronado, CA, USA; January 26–28, 2023.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objective
To investigate the impact of neighborhood-level social vulnerability on pediatric tonsillectomy outcomes.
Methods
This single-center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two-sided Pearson chi-square tests were used, whereas for continuous variables, paired t-tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post-T&A complications and readmissions.
Results
The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128–22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270–28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275–31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293–79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089–29.396).
Conclusion
Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community-based interventions. Because of the increased risk, it may have implications for preoperative decision-making, treatment plans, and clinic follow-ups.
Level of Evidence
3. Laryngoscope, 134:954–962, 2024
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