BACKGROUND Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.

中文翻译：

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紧急剖腹手术后的社会经济剥夺和死亡率：一项流行病学观察研究。

背景技术社会经济状况会影响获得医疗保健的机会，所提供的护理标准以及各种结果。这项研究旨在确定急诊剖腹手术后粗略和经风险调整的30天死亡率与社会经济群体之间的关系，测量达到相关围手术期护理标准的差异，并调查医院结构或过程的差异是否可以解释死亡率之间的任何差异。社会经济群体。方法这是一项对58 790例患者的观察性研究，前瞻性收集了2013年12月1日至2016年11月31日在英格兰的178家国家卫生服务医院进行的国家紧急剖腹手术审核的数据，并与国家行政数据库进行了链接。根据每位患者通常的居住地的“多重剥夺五分之一指数”确定社会经济群体。结果总体而言，粗略30天死亡率为10.3％，最贫穷的五分位数（11.2％）和最贫穷的五分位数（9.8％）之间存在差异（P <0.001）。贫困程度更高的患者更有可能出现多种合并症，在手术时更加不适，需要更紧急的手术。风险调整后，与所有其他五分位数相比，最贫困的五分之一患者的死亡风险显着更高（校正后的优势比[95％置信区间]：第一季度[最贫困]：参考；第二季度：0.83 [0.76-0.92] ]；第3季：0.84 [0.76-0.92]；第4季：0.87 [0.79-0.96]；第5季[最贫乏]：0.77 [0.70-0.86]）。我们没有发现证据表明医院水平结构或患者水平的护理标准差异解释了这种关联。结论在急诊剖腹手术后，被剥夺得更多的患者在30天后的死亡率和经风险调整后的死亡率较高，但这不能通过国家急诊剖腹手术审核中记录的护理标准差异来解释。