Presented by: Antonio Franco MD
Rush University Medical Center

Introduction

Socioeconomic determinants of health (SDOH) are often unvalued during surgery risk stratification; therefore, they might be a major source of disparity that can jeopardize outcomes related to urological surgery. Hence, the aim of our study is to evaluate the impact of SDOH on postoperative outcomes following uro-oncology surgery.

Materials

Patients who underwent major uro-oncology procedures between 2011 and 2021 were retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify the type of surgical operation, patient’s characteristics, postoperative complications and SDOH. Outcomes were compared using multivariable regression models.

Results

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Overall, 275,696 patients (mean age = 62.8 ± 10.6) were identified [Radical Prostatectomy = 135,358 (49%), Radical Cystectomy = 22,670 (8%), Nephrectomy = 98,259 (36%), Nephroureterectomy = 8,981 (3%), Adrenalectomy = 10,428 (4%)]. The 60-day postoperative complication rate was 14.3%. Approximately 7% of patients reported at least one SDOH at baseline. SDOH were associated with higher odds of 60-day postoperative complications (OR:1.21, 95% CI:1.16-1.27), including urinary tract infection (OR:1.30, 95% CI:1.23-1.37) leakage/hematoma (OR:1.10, 95% CI:0.97-1.25), pneumonia (OR:1.26, 95% CI:1.15-1.40), deep vein thrombosis (OR:1.22, 95% CI:1.10-1.36), sepsis (OR:1.08, 95% CI:0.99-1.17), wound defect (OR:1.23, 95% CI:0.97-1.54), acute kidney injury (OR:1.20, 95% CI:1.14-1.27) and pulmonary embolism (OR:1.14, 95% CI:1.01-1.29).

Conclusion

SDOH minorities have significantly higher risk of postoperative complications following uro-oncological surgery. Early identification of these disparities may help stratifying high-risk patients undergoing major uro-oncological procedures.

Funding

None

Co-Authors

Morgan R. Sturgis, MD
Rush University Medical Center

Francesco Ditonno, MD
Rush University Medical center

Celeste Manfredi, MD
Rush University Medical Center

Jamie Joon, MD
Rush university medical center

Daniel Roadman, MD
Rush university medical center

Adan Z. Becerra,
Rush university medical center

Srinivas Vourganti,
Rush university medical center

Riccardo Autorino,
Rush university medical center

Ephrem O. Olweny,
Rush university medical center