Zip code and hospital quality may both affect the risk of dying after surgery

People who lived in under-resourced neighborhoods and underwent operations at lower-quality hospitals were more likely to die within 30 days.

10:50 AM

Author | Mary Clare Fischer

Surgery 3300
Justine Ross/Jacob Dwyer/Michigan Medicine

Living in an under-resourced neighborhood may affect a person’s recovery from surgery, even if their operation takes place at a high-quality hospital, according to a large study of Medicare patients.

A University of Michigan-led research team analyzed whether the death rate in the 30 days after five common operations was tied to hospital quality, as calculated by the Centers for Medicare & Medicaid Services, and/or zip code for close to 2 million patients covered by Medicare.

They documented widespread variation across the United States for both measures, including that where patients lived did not predict whether they underwent their operations at high- or low-quality hospitals.

However, living in a neighborhood with high poverty levels, low education rates and worse quality housing increased the likelihood that a patient died after surgery, whether their procedure took place at a high-quality hospital or not. Similarly, undergoing surgery at a lower-quality hospital put patients at similar risk of dying after their operations, even if they lived in neighborhoods with higher incomes and education levels.

These findings support community benefit and other policies designed to incentivize investment in and examination of the roles hospitals play in advancing structural equity in the communities they serve.” Adrian Diaz, M.D., M.P.H.

“In other words, patients from the most deprived neighborhoods going to the highest-rated hospitals have a similar risk of death as those in the least deprived neighborhoods going to the lowest-quality hospitals,” said Andrew M. Ibrahim, M.D., MSc., co-director of the Center for Healthcare Outcomes & Policy at Michigan Medicine, a member of Precision Health, a surgeon at University of Michigan Health and the senior author of the study.

Patients who both lived in under-resourced neighborhoods and underwent surgeries at low-quality hospitals had the highest death rate (all death rates were in the single digits.)

“These findings support community benefit and other policies designed to incentivize investment in and examination of the roles hospitals play in advancing structural equity in the communities they serve,” said Adrian Diaz, M.D., M.P.H., a research fellow at Michigan Medicine, a general surgery resident at Ohio State University and the first author of the study.

Health care systems are increasingly developing pilot programs to identify patients who live in neighborhoods at increased risk of poor surgical outcomes and creating programs to try to improve those patients’ health before surgery. For example, Michigan Medicine leads an initiative called Michigan Social Health Interventions to Eliminate Disparities, also known as MSHIELD, funded by Blue Cross Blue Shield of Michigan that partners with health and human services organizations across the state of Michigan to do this type of work.

Additional authors include Stacy Tessler Lindau of the University of Chicago; Samilia Obeng-Gyasi of Ohio State University; Justin Dimick and John Scott of Michigan Medicine

Diaz receives funding from the University of Michigan Institute for Healthcare Policy and Innovation’s Clinician Scholars Program. Dimick and Ibrahim receive grant funding from the National Institutes of Health. Lindau’s effort was supported in part by the NIH grant and the National Institute on Aging.

Paper cited: “Association of Hospital Quality and Neighborhood Deprivation With Mortality After Inpatient Surgery Among Medicare Beneficiaries,” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2022.53620

More Articles About: Post Operative and Recovery Health Care Delivery, Policy and Economics Demographics Research
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories Illustration of girl with blue water line, depicting a figure drowning, as girl contemplates pill in hand
Health Lab
Antidepressant dispensing to adolescents and young adults surges during pandemic
Rate of antidepressant dispensing to young people rose faster after March 2020, especially among females
Scale pictured behind a hospital room curtain
Health Lab
Obesity care can make a big difference, but few get it, study suggests
Obesity care under a health care provider’s supervision, whether through nutrition counseling, medication, meal replacement or bariatric surgery, can help people with high BMI, but many don’t receive it.
Woman in pink shirt lifts kettleball in an outdoor exercise class
Health Lab
How to make cancer prevention more equitable
Expert explains six behavioral risk factors for cancer and why current programs don’t always meet the needs of people from racially and ethnically minoritized groups and other vulnerable populations.
illustration of man sleeping in bed with CPAP machine on
Health Lab
Free sleep clinic addresses disparities in treatment of sleep disorders
New sleep medicine service aims to combat sleep disorders and help reduce poor health outcomes for people without health insurance.
Health Lab Podcast in brackets with a background with a dark blue translucent layers over cells
Health Lab Podcast
Access to Plan B coincides with a drastic decrease in emergency contraception-related ER visits, study shows
U.S. emergency departments see 96% fewer visits, $7.6 million less in medical costs after FDA approval of over the counter emergency contraception.
News Release
Statewide cardiovascular consortium, hosted at Michigan Medicine, receives national award for patient safety, quality efforts
A collaborative partnership dedicated to improving statewide cardiovascular care and outcomes — hosted at Michigan Medicine — received national recognition for efforts in patient safety and quality. BMC2 received the award for its significant improvements in the documentation of radiation use, a decrease in high-dose radiation exposure and reduction in opioid prescribing rates for patients.