The Social Vulnerability Index is Associated with Major Morbidity or Mortality After Esophagectomy for Esophageal Cancer

Background: Social determinants of health are increasingly recognized as critical contributors to surgical outcomes. The Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC), reflects community-level factors such as socioeconomic status, housing, and access to transportation. Its association with postoperative outcomes after esophagectomy for esophageal cancer remains poorly defined. Methods: Patients who underwent esophagectomy at a single institution from 2009 to 2022 were identified. Major morbidity was defined using the Society of Thoracic Surgeons’ criteria. Patients were excluded for missing clinical stage, metastatic disease at diagnosis, non-Illinois residency, or incomplete address. The study assigned SVI using patient zip codes mapped to CDC census-tract-level SVI data. Uni- and multivariable logistic regression assessed associations between SVI and 30-day composite major morbidity and mortality. Results: Among 103 patients (median age, 63, years; interquartile range [IQR], 56–70 years), 24% (25/103) were female, 72% (74/103) were white, 48% (49/103) underwent minimally invasive surgery, 36% (37/103) received neoadjuvant therapy, and 64% (66/103) were smokers. Major morbidity occurred for 49% (50/103), including two deaths. Higher SVI was associated with worse outcomes in both the univariable (odds ratio [OR], 6.86; 95% confidence interval [CI], 1.65–28.51; p = 0.01) and multivariable (OR, 17.37; 95% CI, 3.29–91.80; p = 0.001) analyses. An SVI cut-point of 0.34 identified high-risk patients with 70% sensitivity, 60% specificity, and predictive values of 63% (positive) and 68% (negative). Conclusion: Higher SVI was associated with increased 30-day major morbidity or mortality after esophagectomy for esophageal cancer. These findings are hypothesis-generating and warrant validation in larger, multi-institutional cohorts.