Social determinants of health and surgical outcomes of minimally invasive radical prostatectomy: a national population-based study.

Abstract

Background: Socioeconomic determinants of health (SDOH) are often unvalued during surgery risk stratification; hence, they might be a major source of disparity that can jeopardize outcomes related to urological surgery. The aim of our study is to evaluate the impact of SDOH on postoperative outcomes following minimally invasive radical prostatectomy (MIRP).

Methods: Patients who underwent MIRP 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 patient's characteristics, postoperative complications and SDOH. Outcomes were compared using multivariable regression models.

Results: Overall, 100,035 patients (mean age = 63.24 ± 7.07) underwent MIRP. The 60-day postoperative complication rate was 18%. Approximately 6% of patients reported at least one SDOH at baseline. SDOH were associated with higher odds of 60-day postoperative complications (OR:1.24, 95% CI:1.15-1.34), including urinary tract infection (OR:1.32, 95% CI:1.20-1.45) and acute kidney injury (OR:1.31, 95% CI:1.00-1.39). Postoperative urethral stricture (OR:1.37, 95% CI:0.92-1.98) did not reach statistical significance at multivariable analysis.

Conclusions: Patients with SDOH have a significantly higher risk of postoperative complications following MIRP, especially urinary infection and acute kidney injury. These findings are multifactorial and should prompt identifying measures that might help prevent this large-scale phenomenon.