Social Determinants of Health and Postoperative Complications Among Women Undergoing Benign Minimally Invasive Gynecologic Surgery

INTRODUCTION: Social determinants of health (SDoH) are nonmedical factors that influence health outcomes and have been shown to impact postoperative outcomes in other specialties; however, these have not been thoroughly investigated among a benign gynecologic population. OBJECTIVE: The objective of this study was to compare postoperative complications between women undergoing minimally invasive gynecologic surgery (MIGS) with a positive screen on any SDoH domain in the previous 12 months with those having no positive screens. METHODS: A retrospective cohort study of women undergoing benign, routine minimally invasive gynecologic surgery by a MIGS-trained surgeon between 1/1/2023 and 7/1/2024 was done. Women with no SDoH screening and those having emergency gynecologic procedures were excluded. Demographic and clinical variables were collected, and SDoH screening within the preceding 12 months was recorded. SDoH domains are listed in Table 1. The primary outcome was a composite of postoperative complications within 30 days (readmission, reoperation, or emergency room visit). Standard statistical tests of comparison were used. RESULTS: 1,125 MIGS surgeries occurred during the study time with 663 meeting eligibility criteria. Mean age was 38.8 years, median BMI was 29.3, and 85.2% were White. Most women underwent hysterectomy (n=377, 57.0%) and/or excision of endometriosis (n=339, 51.2%; Table 2). Those with fibroids as an indication for surgery were less likely to screen positive for any SDoH domain in the preceding 12 months (positive screen, n=22 [13.0%]; negative screen, n=100 [20.3%]; p=0.04). Other clinical and surgical variables are listed in Table 2. One-quarter of women had a positive screen on at least 1 domain in the preceding 12 months (n=169, 25.5%). Positive SDoH screens are listed in Table 1. Our primary outcome, composite postoperative complications, was similar between groups (positive screen within 12 months=23 [13.6%], negative screen=52 [10.6%], p=0.28). Only 44 women were screened for SDoH needs on the day of surgery. Six out of 44 women (13.6%) screened positive for at least one SDoH domain on day of surgery. These women had a higher rate of postoperative complications (3 (50.0%) vs negative screen=6 (15.7%), p=0.054). No individual SDoH domains within 12 months were significantly associated with increased postoperative complication rates. CONCLUSIONS: There was no difference in postoperative complications among women undergoing benign minimally invasive gynecologic surgery with a positive SDoH screen in the preceding 12 months compared to those with only negative screens; however, despite small numbers, there was a difference in those who had a positive screen on the day of surgery. Identification of at-risk populations by SDoH screening may allow for development of interventions to decrease postoperative complications. More investigation is needed to understand how SDoH variables impact a MIGS population.