Patient-reported health-related social needs obtained at the bedside and outcomes after elective major surgery

Evidence supports an association between social determinants of health and surgical outcomes. Still, there is a gap in the literature on point-of-care, patient-level social needs data in the perioperative period. This study used a routine bedside screening tool to assess the independent association of patient-reported health-related social needs with surgical complications.

This was a retrospective study of patients undergoing elective major thoracic or abdominal surgery across a statewide health care system. Upon admission for elective surgery, patients were screened for 4 core health-related social need domains on the basis of the Accountable Health Communities Health-Related Social Needs Screening Tool (January 2022 to June 2023). These data were linked with internal databases collected for the Society of Thoracic Surgeons General Thoracic Surgery Database and the National Surgical Quality Improvement Program. The primary outcome was any 30-day postoperative complication.

Of 1,172 patients screened, 356 underwent thoracic surgery, and 816 underwent abdominal surgery. In total, 6.1% (n = 72) reported at least 1 health-related social need. On adjusted analysis, patients with at least 1 health-related social need had 1.8 times the odds of any 30-day complication than patients without health-related social needs (odds ratio, 1.78; 95% confidence interval, 1.02-3.11; P = .043). Patients with at least 1 health-related social need domain had more extended hospital stays (median, days, 4.5 vs 4.0; P = .048) and were less likely to be discharged to a permanent residence (15.3% vs 5.5%, P < .001).

This is the first study to evaluate the association of health-related social needs, obtained from the AHC health-related social need Screening Tool, with surgical outcomes, finding that patients who reported health-related social needs were more likely to experience complications after major surgery. Future studies should investigate the individual health-related social needs driving inequities in surgical care to inform the design of preoperative interventions.