K. Misselbrook, P. Arnold

Alder Hey Children's Hospital, UK


Deprivation is a risk factor for adverse health outcomes in children, including an increased incidence of surgical disease(1).  More deprived families also find barriers to accessing treatment and their children may have worse peri-operative outcomes(2, 3).  Pre-assessment provides a means to help address these inequalities, however if access to pre-assessment is itself inequable, this may instead exacerbate the problem.


Data previously recorded from a quality improvement project (during two time periods, August 2022 and August 2023) was matched to patient’s postal codes. The postal code was then matched to a single Lower Layer Super Output Areas (LSOA). An LSOA is a geographical area defined in the 2011 census, typically of 400-1200 households. The LSOA was then matched to 2019 deprivation data. Three indexes of deprivation are considered: English Index of Multiple Deprivation (IMD); a domain of the IMD representing educational deprivation (ED); and a measure of income deprivation specific to children (IDACI).   Whist the first two indexes are only available for families with English post codes the latter is also available for Welsh families. A comparison was made between children living in areas in the lowest quintile and those living in all other areas.  The outcome was whether the family engaged with our pre-op service either at an initial or follow-up phone calls.  Analysis was conducted using the R statistical language (code and a list of all data sources is available on request).


Table one summarises the results. Out of 1873 children referred to the preop service we were able to contact and triage 1593 (85%) at an initial phone call and a further 180 at follow up calls (9.6%). English or Welsh postcodes were matched to 1553 and 157 retrospectively. 739 (48%) children lived in areas with the highest quintile of deprivation by IMD.

There was a trend towards lower success rates in contacting families for those living in more deprived areas. Confidence intervals for relative risk include one, meaning there is residual uncertainty in this result.

Discussion and conclusion

Whilst it was more common that our per-op service was unable to successfully contact families from the most deprived areas, the small numbers mean there is still considerable uncertainty as to the presence or magnitude of this effect. Whilst much of the analysis could be automated the initial data collection was limited by a need to manually examine patient records.

It is the authors view that this issue, and other issues effecting children’ access to surgical care and perioperative outcomes require further study. This should include further quantitively population-based research such as this study. There are limitations to this approach and more detailed qualitative work involving smaller groups of patients is also likely to be required.


  1. Hulse K, Lindsay E, Rogers A, Young D, Kunanandam T, Douglas CM. Twenty-year observational study of paediatric tonsillitis and tonsillectomy. Arch Dis Child. 2022;107(12):1106-10.
  2. Cockrell H, Barry D, Dick A, Greenberg S. Socioeconomic disadvantage and pediatric surgical outcomes. Am J Surg. 2023;225(5):891-6.
  3. Barlow P, Mohan G, Nolan A, Lyons S. Area-level deprivation and geographic factors influencing utilisation of General Practitioner services. SSM Popul Health. 2021;15:100870.
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