Stronger together: Impact of social capital on gastrointestinal cancer surgery outcomes among older adults.

Abstract

We sought to investigate the association between social capital and postoperative outcomes among patients undergoing gastrointestinal cancer surgery. Medicare Standard Analytic Files were queried to identify individuals who underwent gastrointestinal cancer surgery between 2007 and 2019. Patient residential addresses at the county level were linked with social capital data. Multivariable regression was used to examine the association between low social capital and textbook outcome. Textbook outcome is a composite measure of optimal perioperative care. A total of 114,647 individuals were included in the analytic cohort. Median patient age was 74 years (interquartile range, 70-80), most patients were female (n = 59,189, 51.6%), and had a Charlson Comorbidity Index score of ≤2 (n = 47,963, 41.8%). Of note, 38.3% (n = 43,942) resided in low social capital neighborhoods. Overall, 49.3% of patients achieved a textbook outcome; individuals with low social capital were less likely to achieve a textbook outcome (47.5% vs 51.7%; P < .001). Specifically, patients living in low social capital neighborhoods were more likely to experience complications (29.8% vs 26.0%), readmission (25.3% vs 24.4%), extended length of stay (24.1% vs 20.2%), and death within 90 days of surgery (10.0% vs 8.0%) (all P < .001). On multivariable analysis, after adjusting for baseline characteristics, patients living in low social capital neighborhoods had 12% lower odds of achieving a textbook outcome (odds ratio, 0.88; 95% confidence interval, 0.84-0.92). Individuals living in neighborhoods with low social capital experienced worse outcomes after gastrointestinal cancer surgery. There is a need for interventions that strengthen community connections and build trust in health care systems.