The Impact of Social Determinants of Health on Severe Colorectal Complications

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.