Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807758
Review Article

The Impact of Social Determinants of Health on Severe Colorectal Complications

Wendelyn M. Oslock
1   Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Quality, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
,
Leanne D. Jeong
3   School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Mei Lin N. Dye
4   East Tennessee State University, College of Medicine, Johnson City, Tennessee
,
Meet Patel
5   Gujarat Medical Education and Research Society, Medical College, Gandhinagar, Gujarat, India
,
Daniel I. Chu
1   Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
› Institutsangaben

Funding D.I.C. was supported in part by K12 HS023009 (2017–2019), K23 MD013903 (2019–2022), R01 MD013858 (2020–2025), and R01 CA271303 (2023–2028). W.M.O. was supported by the AAS/AASF Clinical Outcomes/Health Services Trainee Research Award and the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations VA Quality Scholars Advanced Fellowship Program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government (Program Award Number 3Q022019C).
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Abstract

Complications following colorectal surgery remain a persistent issue despite advances in surgical technique, development of enhanced recovery, and improvements in perioperative care. Social determinants of health (SDOHs) at the individual, interpersonal, institutional, community, and policy levels have been associated with the risk of patients experiencing a complication. At the individual level, race and ethnicity are associated with complications, with the Black race having the most robust data demonstrating increased risk for complication. Additional individual-level factors associated with complications include food insecurity, health literacy, or the presence of an SDOH diagnostic Z-ICD code. Institutionally, hospital size, case volume, and teaching status were characteristics associated with the risk of complications, while safety net status was not. Hospital and home rurality, as well as food deserts, are community-level characteristics associated with an increased likelihood of complication. For policy-level SDOH, insurance type was associated with complications. Specifically, patients with Medicare, Medicaid, uninsured, or a combination of the three were more likely to experience a complication than a patient with private insurance. Additionally, composite measures for SDOH, such as the social vulnerability index, are associated with postoperative complications. There are SDOH at each level that influence the risk of complications following colorectal surgery, highlighting the need to incorporate these factors into quality improvement efforts.



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Artikel online veröffentlicht:
24. April 2025

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