31 - YOUR ZIP CODE MATTERS: INFLUENCE OF NEIGHBORHOOD LOCATION ON OUTCOMES IN OLDER ADULTS UNDERGOING EMERGENCY GENERAL SURGERY PROCEDURES

Objectives: Neighborhood location and its built environment are important social determinants of health that have been shown to contribute to health inequities and significantly impact health outcomes and quality of life. Older adults (OAs) represent the fastest growing population in the United States with an associated increase in the proportion requiring emergency general surgery procedures (EGSPs). The aim of this study was to evaluate whether neighborhood location, represented by zip code, influences mortality, and change in residence at discharge in OAs undergoing EGSPs in Maryland

Methods: A retrospective review of hospital encounters in the Maryland Health Services Cost Review Commission from 2014-2018 of OAs undergoing urgent/emergent EGSPs, was undertaken. Comparisons were made between OAs residing in the 50 most affluent (MANs) and 50 least affluent (LANs) neighborhoods, based on zip codes and census income level data. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR- risk of mortality (ROM), Charlson Comorbidity Index, EGSPs (including partial colectomy, small bowel resection, cholecystectomy, lysis of adhesions, appendectomy, and laparotomy), mortality, and change in residence (discharge to a higher level of care compared to baseline). Univariable and multivariable regression models were utilized to conduct the analysis. P-values (p < 0.05) were deemed significant

Results: Of the 8,661 OAs included in the analysis, 2,362 (27.3%) resided in MANs and 6,299 (72.7%) in LANs. Demographics, severity of illness, EGSPs performed, and outcomes are represented in Table 1. OAs in LANs where more likely to undergo EGSPs, presented with higher APR-SOI and APR-ROM, and experienced an increased frequency of complications, discharge to higher level of care, and mortality. (Table 1) After adjusting for confounders, living in LANs was independently associated with discharge to higher level of care (OR 1.56, 95% CI: 1.38-1.77, p< 0.001) and increased mortality (OR 1.35, 95% CI: 1.07-1.71, p=0.01).

Conclusion: Mortality and quality of life in OAs undergoing EGSPs are dependent on where they live. Neighborhood variations in the quality of available housing, food, employment, transportation, and access to healthcare maybe the driving force behind these differences. Future efforts should focus on developing a better understanding of these factors and incorporating them into clinical predictive models to improve health outcomes. Additionally, public health initiatives should focus on leveraging the built environment to promote health and health equity as the demographic shift unfolds.