Exploring the Nexus: Socioeconomic Indices and Their Influence on Patient-Reported Outcomes in Oncologic Reconstructive Surgery at a Quaternary Care Center

INTRODUCTION: The role of socio-environmental determinants in shaping postoperative outcomes, especially in the context of oncologic surgeries like lower extremity soft tissue sarcoma (STS) reconstructions, warrants deeper exploration given their noted impact across various surgical disciplines (1). This research aims to dissect the connection between socioeconomic factors, as gauged by the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI), and the outcomes reported by patients following their surgeries. METHODS: Our study was a single-institution, IRB-approved retrospective analysis of patients treated for lower extremity soft tissue sarcoma from 2016 to 2021. Data from 302 STS patients were analyzed for complications and patient-reported outcomes using PROMIS-29 (Patient-Reported Outcomes Measurement Information System) and TESS (Toronto Extremity Salvage Scale) surveys calibrated to 6 months postoperatively. Socioeconomic status (SES) was assessed through ADI and SVI scores, categorized into tertiles. Statistical analysis involved Chi-square, Fisher exact tests, and logistic regression using SPSS V26.0. RESULTS: Within the SVI categories for 302 patients, complication percentages were observed as follows: 33.3% in the high vulnerability group, 36.2% in the intermediate vulnerability group, and 42.6% in the low vulnerability group. Similarly, for ADI categories, the rates were 30.7% for the high deprivation group, 48.1% for the intermediate deprivation group, and 40.2% for the low deprivation group. The response rate for the TESS survey was recorded at 17.96%, with 46 out of 256 patients providing feedback. Similarly, the PROMIS-29 survey yielded a participation rate of 17.19%, with 44 out of 256 patients responding. The physical function domain in the PROMIS-29 survey revealed significant differences across ADI tertiles (p=0.035), with higher ADI associated with lower physical function scores, indicating a poorer quality of life. No significant differences were observed in other domains or across SVI tertiles. TESS scores did not vary significantly by SES, indicating uniform functional recovery irrespective of socioeconomic background. DISCUSSION: The minimal differences in patient-reported outcomes highlights the complex interplay of factors influencing postoperative recovery. The significant finding in the physical function domain among higher ADI tertiles suggests potential underreporting of difficulties by lower SES groups, possibly due to cognitive biases shaped by lifelong socioeconomic challenges (2). This underlines the necessity of incorporating socioeconomic awareness into surgical care to identify and address potential barriers to recovery, ensuring equitable patient outcomes. REFERENCES: 1. Mehaffey, J. H., Hawkins, R. B., Charles, E. J., et al. Socioeconomic “Distressed Communities Index” improves surgical risk adjustment. Annals of Surgery, 2020;271:470-474. 2. Hao, Y., Evans, G. W., Farah, M. J. Pessimistic cognitive biases mediate socioeconomic status and children’s mental health problems. Scientific Reports, 2023;13:5191.