title: Influence of Social Deprivation on Outcome of Open Arterial Surgery in Tertiary Care: An Observational Study.
abstract: OBJECTIVE
  Health equity is playing an increasing role in British government health policy. Evidence of social deprivation affecting outcomes in surgery is poor. This study aimed to assess the influence of social deprivation on the outcome of major arterial surgery.
  
  
  METHODS
  A retrospective cohort study was undertaken in patients undergoing elective or emergency open surgery for abdominal aortic aneurysms or lower limb arterial reconstruction over an eight and a half year period within one institution. Patient deprivation was calculated for each patient with the Index of Multiple Deprivation (IMD) score. This was then entered into multivariate models to determine its effect on mortality and postoperative length of stay after adjustment for confounders.
  
  
  RESULTS
  Five hundred and six patients were included in the study. There were 45 deaths (8.9%) and median (IQR) postoperative length of stay was 8 (4-15) days. The median (IQR) IMD score was 46.4 (28.3-64.5). IMD score correlated with ASA grade and was significantly higher in smokers, patients with respiratory disease and those with left ventricular failure. IMD (OR = 1.01; 95% CI = 0.99-1.03; p = .45) did not affected mortality, which was associated with aortic surgery, emergency surgery, and high ASA grade. Postoperative length of stay, which was longer with/after aortic surgery, tissue loss, emergency surgery, high ASA grade, low haemoglobin, and age over 80 years was also independent of deprivation (Spearman's rho = -0.49, p = .28).
  
  
  CONCLUSIONS
  No effect of social deprivation on mortality or length of stay in patients undergoing major arterial surgery was identified.
authors.affiliation: a Liverpool Vascular and Endovascular Service , Royal Liverpool University Hospital & University Hospital Aintree , Liverpool , UK.
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: a Liverpool Vascular and Endovascular Service , Royal Liverpool University Hospital & University Hospital Aintree , Liverpool , UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Green
authors.affiliation: a Liverpool Vascular and Endovascular Service , Royal Liverpool University Hospital & University Hospital Aintree , Liverpool , UK.
authors.forename: J R H
authors.initials: JR
authors.lastname: Scurr
authors.affiliation: a Liverpool Vascular and Endovascular Service , Royal Liverpool University Hospital & University Hospital Aintree , Liverpool , UK.
authors.forename: F
authors.initials: F
authors.lastname: Torella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011610:Psychosocial Deprivation; D012189:Retrospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: health outcomes; social deprivation; surgical outcomes; vascular surgery