Impact of Social Determinants of Health on Post-operative Outcomes Following Robotic Radical Prostatectomy

Social determinants of health are increasingly recognized as key contributors to disparities in healthcare access and outcomes. With robotic-assisted radical prostatectomy now widely adopted as the preferred surgical approach for localized prostate cancer, this systematic review evaluates how individual social determinants of health influence access to robotic surgery and postoperative outcomes.

This review adhered to PRISMA guidelines and was registered with PROSPERO (CRD420256270179). A comprehensive search of PubMed and EBSCO identified studies examining social determinants of health in patients undergoing robotic prostatectomy. Extracted data included patient demographics, social determinants of health variables, and perioperative outcomes. Risk of bias was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.

Eighteen studies met inclusion criteria. Commonly assessed variable included socioeconomic status, race/ethnicity, insurance, education, occupation, and geographic location. Lower socioeconomic status was linked to decreased robotic prostatectomy access, treatment at low-volume or non-robotic centers, and worse outcomes. Racial and ethnic disparities were consistent; non-White patients were less likely to receive definitive therapy and more likely to undergo surgery by low-volume providers. Rural patients experienced reduced access to robotic surgery and lower rates of pelvic lymph node dissection. Lower education levels were associated with delayed continence and reduced return-to-work capacity.

Social determinants of health significantly impact access to robotic prostatectomy and postoperative outcomes. Urologists and policymakers should integrate awareness of these factors into patient counseling and institutional planning. Future research should explore mechanisms underlying these disparities to inform equity-driven strategies in prostate cancer care.