Work

Understanding the impact of socioeconomic deprivation on inpatient surgical care delivery costs in the Veterans Health Administration

Year: 2026

Type: article

Abstract: The impact of living in high neighborhood-level socioeconomic deprivation on inpatient surgery cost is unknown. This retrospective cohort study examines the relationship between Area Deprivation Index (ADI) and inpatient surgery costs in the Veterans Health Administration (VHA). Patients aged ≥65 years undergoing inpatient surgery during 2013-2019 were identified in Veterans Affairs Surgical Quality Improvement Program data linked to additional VHA data sources. The cohort includes 136,631 predominantly male (97.7%) cases with mean (SD) age of 72 (6.5) years. The 20,462 cases with high ADI (>85) were more often Black race (27% vs 13.6%) with higher comorbidity burden (Gagne score 3.4 vs 3.1), higher frailty (29.1 vs 28.7), and more likely presenting with preoperative acute serious conditions (5.6% vs 4.5%) for more urgent (21.3% vs 18.7%) or emergent surgery (8.9% vs 8.1%, all p<0.001). After adjusting for facility with ordinary least square regression, the mean cost was $966 higher (95% CI, $634-$1298; p<0.001) in cases with ADI>85. Unconditional quantile regression demonstrated even higher costs of >$1,500 for patients at or above the 75th cost quantile. The higher costs are eliminated after adjusting for patient comorbidity and frailty (-$33; 95% CI, - $338-$271; p=0.83) and presentation acuity (-$88; 95% CI, -$386-$211; p=0.57). Among older patients undergoing inpatient surgery in the VHA, ADI>85 is associated with higher surgical cost, explained by patient comorbidity and frailty, and presentation acuity; thus, suggesting a potentially cost-saving opportunity to mitigate barriers to healthcare access and other downstream effects of high neighborhood-level socioeconomic deprivation before surgery becomes urgent.

Source: Social Sciences & Humanities Open

DOI: 10.1016/j.ssaho.2026.102705