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How Can We Improve Surgical Care of Patients Who Are Homeless?

To identify the key insights or developments described in this article
1 Credit CME

Homelessness is a national crisis. In the US, 580 466 people experienced homelessness on 1 night in 2020, up by 2.2% from 2019.1 Compared with housed individuals, unhoused people have higher rates of chronic health conditions and mental illness, are hospitalized younger, and face barriers to obtaining adequate primary and preventive health care. To date, much of the scientific literature has focused on the medical and psychiatric care of the homeless population, with little research performed to guide surgical teams in tailoring surgical care and ensuring equitable delivery to the unhoused. Housing status undoubtedly affects surgical management, from preoperative assessment and preparation to intraoperative decision-making to postoperative care and rehabilitation (Figure). As homelessness rates rise, equipping surgeons with the tools to provide equitable, patient-centered care for this vulnerable population will be vital.

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Article Information

Corresponding Author: Elizabeth C. Wick, MD, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave, S-321, San Francisco, CA 94143 (elizabeth.wick@ucsf.edu).

Published Online: July 6, 2022. doi:10.1001/jamasurg.2022.2586

Conflict of Interest Disclosures: Dr Lin reported grants from the National Health Institutes (T32CA25107001) during the conduct of the study. Dr Wick reported grants from AHRQ during the conduct of the study (1R01HS024532-01A1). No other disclosures were reported.

Additional Contributions: The authors thank Margot Kushel, MD, University of California, San Francisco, and Zuckerberg San Francisco General Hospital for critical review and feedback on the manuscript. Additionally, we thank Pamela Derish, University of California San Francisco, Department of Surgery, and Hope Schwartz, BA, University of California School of Medicine, for editorial assistance and manuscript preparation.

References
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Office of Policy Development and Research. Part 1—PIT estimates of homelessness in the US. Accessed February 18, 2022. https://www.huduser.gov/portal/datasets/ahar/2020-ahar-part-1-pit-estimates-of-homelessness-in-the-us.html
2.
Titan  A , Graham  L , Rosen  A ,  et al.  Homeless status, postdischarge health care utilization, and readmission after surgery.   Med Care. 2018;56(6):460-469. doi:10.1097/MLR.0000000000000915PubMedGoogle ScholarCrossref
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Thakarar  K , Rokas  KE , Lucas  FL ,  et al.  Mortality, morbidity, and cardiac surgery in injection drug use (IDU)-associated versus non-IDU infective endocarditis: the need to expand substance use disorder treatment and harm reduction services.   PLoS One. 2019;14(11):e0225460. doi:10.1371/journal.pone.0225460PubMedGoogle ScholarCrossref
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Bennett  CG , Lu  LY , Thomas  KA , Giori  NJ .  Joint replacement surgery in homeless veterans.   Arthroplast Today. 2017;3(4):253-256. doi:10.1016/j.artd.2017.04.001PubMedGoogle ScholarCrossref
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Balla  S , Alqahtani  F , Alhajji  M , Alkhouli  M .  Cardiovascular outcomes and rehospitalization rates in homeless patients admitted with acute myocardial infarction.   Mayo Clin Proc. 2020;95(4):660-668. doi:10.1016/j.mayocp.2020.01.013PubMedGoogle ScholarCrossref
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Asgary  R , Alcabes  A , Feldman  R ,  et al.  Cervical cancer screening among homeless women of New York City shelters.   Matern Child Health J. 2016;20(6):1143-1150. doi:10.1007/s10995-015-1900-1PubMedGoogle ScholarCrossref
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Kushel  MB , Colfax  G , Ragland  K , Heineman  A , Palacio  H , Bangsberg  DR .  Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection.   Clin Infect Dis. 2006;43(2):234-242. doi:10.1086/505212PubMedGoogle ScholarCrossref
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