Impact of Social Vulnerability and Allostatic Load on Postoperative Outcomes.

Abstract

We sought to investigate the association between allostatic load (AL), social vulnerability, and postoperative outcomes following hepatopancreatobiliary (HPB) cancer surgery. Individuals who underwent HPB surgery were identified using the Epic Cosmos database. AL was calculated based on 10 biomarkers across four physiological systems: cardiovascular, metabolic, renal, and immune. Multivariable regression models were used to examine the association between AL, postoperative outcomes, and failure to rescue (FTR). Among 34,253 individuals, mean patient age was 71 years (interquartile range 63-78). Approximately half of patients were male (n = 18,045, 52.7%) and had a high Charlson Comorbidity Index (CCI) score (CCI >2; n = 29,246, 85.4%). The most common cancer site was the pancreas (n = 21,402, 62.5%), followed by the liver (n = 8451, 24.7%) and the biliary tract (n = 4400, 12.8%). Overall, 13.8% (n = 4717) of patients had high AL. On multivariable analysis, the risk of allostasis increased stepwise with higher social vulnerability (reference: low; medium: odds ratio [OR] 1.11, 95% confidence interval [CI] 1.04-1.19; high: OR 1.17, 95% CI 1.11-1.17). Moreover, high AL was associated with a 44% increased risk of Clavien-Dindo grade IV complications (OR 1.44, 95% CI 1.36-1.54) and an 85% increased risk of FTR (OR 1.85, 95% CI 1.60-2.13). In addition, the risk of 30-day mortality was approximately twofold higher with elevated AL (OR 1.92, 95% CI 1.70-2.19). Individuals residing in socially vulnerable areas experience socioeconomic stressors that contribute to long-term physiological damage, resulting in worse outcomes following surgery.