Surgical Care of People Experiencing Homelessness: A Canadian Hospital System Retrospective Review

INTRODUCTION: Surgical care for people experiencing homelessness is not well described in a universal healthcare context. This study describes in-hospital surgical encounters and procedures for people experiencing homelessness with Canadian data. METHODS: This retrospective chart review covers a 1-y period (January 1, 2019 to December 31, 2019) at two tertiary care hospitals in Hamilton, Ontario, Canada. Patients experiencing homelessness were identified by a listed postal code of a shelter or transitional housing location, or with no fixed address. Patients who received a surgical consultation during an emergency department visit or an in-patient admission to hospital were included. Descriptive statistics were used to characterize patient demographics, consultations, and operations. RESULTS: Ninety unhoused patients received care within 129 encounters; 41 were visits to the emergency department and 88 were admissions to hospital. There were 18 trauma activations. Orthopedic surgery, general surgery, and plastic surgery had the highest numbers of consults and procedures. In total, 85 procedures were completed. The average length of stay per admission was 16.1 d (standard deviation = 32.9 d). Of 129 encounters, 21.7% were associated with a complication and 17.1% with unplanned readmission. Rates of substance use and self-directed discharge from hospital were high in this population. CONCLUSIONS: Compared to other settings, this population experienced similar length of stay, complication, and readmission rates, but had significantly higher rates of substance use and self-directed discharge. Providing better symptom management and addiction support and reducing discrimination and restrictive policies may improve patients' experience in hospital and reduce self-directed discharges.