Social Determinants of Health and Preoperative Care

Predictive Value of Social Determinants of Health on 90-Day Readmission and Health Utilization Following ACDF: A Comparative Analysis of XGBoost, Random Forest, Elastic-Net, SVR, and Deep Learning

Study DesignRetrospective cohort.ObjectiveDespite numerous studies highlighting patient comorbidities and surgical factors in postoperative success, the role of social determinants of health (SDH) in anterior cervical discectomy and fusion (ACDF) outcomes remains unexplored. This study evaluates the predictive impact of SDH on 90-day readmission and health utilization (HU) in ACDF patients using machine learning (ML).MethodsWe analyzed 3127 ACDF patients (2003-2023) from a multisite academic center, incorporating over 35 clinical and demographic variables. SDH characteristics were assessed using the Social Vulnerability Index. Primary outcomes included 90-day readmission and postoperative HU. ML models were developed and validated by the area under the curve (AUC) for readmission and mean absolute error (MAE) for HU. Feature importance analysis identified key predictors.ResultsBalanced Random Forest (AUC = 0.75) best predicted 90-day readmission, with length of stay, Elixhauser score, and Medicare status as top predictors. Among SDH factors, minority status & language, household composition & disability, socioeconomic status, and housing type & transportation were influential. Support Vector Regression (MAE = 1.96) best predicted HU, with perioperative duration, socioeconomic status, and minority status & language as key predictors.ConclusionsFindings highlight SDH's role in ACDF outcomes, suggesting the value of stratifying for interventions such as targeted resource allocation, language-concordant care, and tailored follow-up. While reliance on a single healthcare system and proxy SDH measures are limitations, this is the first study to apply ML to assess SDH in ACDF patients. Further validation with direct patient-reported SDH data is needed to refine predictive models.

Special Considerations Related to Race, Sex, Gender, and Socioeconomic Status in the Preoperative Evaluation: Part 1: Race, History of Incarceration, and Health Literacy

Patients anticipating surgery and anesthesia benefit from preoperative care to lower risks and facilitate services on the day of surgery. Preparing patients often requires extensive evaluation and coordination of care. Vulnerable, marginalized, and disenfranchised populations have special concerns, limitations, and needs. These patients may have unidentified or poorly managed comorbidities. Underrepresented minorities and transgender patients may either avoid or have limited access to health care. Homelessness, limited health literacy, and incarceration hinder perioperative optimization initiatives. Identifying patients who will benefit from additional resource allocation and knowledge of their special challenges is vital to reducing disparities in health and health care.

The intersection of pediatric anesthesiology and social determinants of health

PURPOSE OF REVIEW

There is increasing evidence of racial and ethnic disparities in pediatric perioperative care, which indicates a need to identify factors driving disparities. Social determinants of health (SDOH) play a fundamental role in pediatric health and are recognized as key underlying mechanisms of healthcare inequities. This article summarizes recent research exploring the influence of SDOH on pediatric perioperative outcomes.

RECENT FINDINGS

Despite the scarcity of research exploring SDOH and pediatric perioperative outcomes, recent work demonstrates an association between SDOH and multiple outcomes across the perioperative care continuum. Measures of social disadvantage were associated with preoperative symptom severity, longer hospital stays, and higher rates of postoperative complications and mortality. In some studies, these adverse effects of social disadvantage persisted even when controlling for medical comorbidities and clinical severity.

SUMMARY

The existing literature offers compelling evidence of the impact of SDOH on perioperative outcomes in children and reveals a critical area in pediatric anesthesia that necessitates further exploration and action. To improve outcomes and address care inequities, future efforts should prioritize the integration of SDOH assessment into pediatric perioperative research and practice.