Association of Neighborhood Opportunity, Race and Ethnicity with Pediatric Day-of-Surgery Cancellations: a Cohort Study

Background Day-of-surgery cancellations impede healthcare access and contribute to inequities in pediatric healthcare. Socially disadvantaged families have many risk factors for surgical cancellation, including low health literacy, transportation barriers, and childcare constraints. These social determinants of health are captured by the Childhood Opportunity Index (COI) 2.0, a national quantification of neighborhood-level characteristics that contribute to a child’s vulnerability to adversity. We studied the association of neighborhood opportunity with pediatric day-of-surgery cancellations. Methods We conducted a retrospective cohort study of children younger than 18 years of age scheduled for ambulatory surgery at a tertiary pediatric hospital between 2017 and 2022. We geocoded the primary address to determine COI 2.0 neighborhood opportunity. We used log-binomial regression to estimate the relative risk of day-of-surgery cancellation comparing different levels of neighborhood opportunity. We also estimated the relative risk of cancellations associated with race and ethnicity, by neighborhood opportunity. Results Overall, the incidence of day-of-surgery cancellation was 3.8%. The incidence of cancellation was lowest in children residing in very high opportunity neighborhoods and highest in children residing in very low opportunity neighborhoods (2.4% vs 5.7%, p<0.001). The adjusted relative risk of day-of-surgery cancellation in very low opportunity neighborhoods compared to very high opportunity neighborhoods was 2.24 (95%CI: 2.05-2.44, p<0.001). We found statistical evidence of an interaction of COI with race and ethnicity. In very low opportunity neighborhoods, Black children had 1.48 times greater risk of day-of-surgery cancellation than White children (95%CI: 1.35-1.63, p<0.001). Likewise, in very high opportunity neighborhoods, Black children had 2.17 times greater risk of cancellation (95%CI: 1.75-2.69, p<0.001). Conclusion We found a strong relationship between pediatric day-of-surgery cancellation and neighborhood opportunity. Black children at every level of opportunity had the highest risk of cancellation, suggesting that there are additional factors that render them more vulnerable to neighborhood disadvantage.