Community-Level Social Capital Predicts High-value Postoperative Outcomes following Intracranial Tumor Surgery

Introduction: A growing body of literature has sought to determine whether patients’ social capital, defined as the system of resources available to individuals through community engagement, is implicated in improved health outcomes. To explore whether community social capital measures, defined as
economic connectedness, community volunteering rates, and number of local civic organizations, are related to surgical outcomes among intracranial tumor patients.

Methods: A retrospective review of a single medical center was conducted to identify adult intracranial tumor patients undergoing resection. Patient ZIP codes were matched to community measures for social capital through the open-access Social Capital Atlas. Chi-square and Mann-Whitney U tests were used to compare demographic and clinical characteristics between patients who were in the 75 and 25 percentiles of each social capital measure. Multivariate logistic regression was used to assess the effect of social capital measures on postoperative outcomes.

Results: A total of 2,373 patients were included in the present study. A majority were white (70.7%), female (53%) and diagnosed with a meningioma (24.0%). On bivariate analysis, patients from communities with higher economic connectedness scores, volunteering rates, and civic organizations were more likely to be White or Asian (p < 0.001 for all) and have lower mFI-5 scores (p=0.003, p=0.006 and p=0.011, respectively).

On multivariate analysis, for every additional civic organization in a patient’s community per 1,000 community members, odds of extended hospital LOS, high hospital costs, and nonroutine discharge disposition was reduced by 60.3% (p=0.006), 63.4% (p=0.008) and 68.9% (p=0.013) respectively. Further, for each point increase in community economic connectedness score and each percent increase in community volunteering rate, odds of extended LOS were reduced by 13.1% (p=0.036) and 23.0% (p=0.011), respectively.

Conclusion : Intracranial tumor patients with low social capital are at-risk for poor high-value care outcomes that may be amenable to case management or social work intervention.