Sociobehavioral Comorbidities and Outcomes After Colectomy in a National United States Veteran Cohort

OBJECTIVE: To evaluate the independent association between sociobehavioral comorbidities (SBCs) and complications after colectomies in a national Veteran cohort. BACKGROUND: SBCs are determinants of health outcomes, and Veterans represent a high-vulnerability population. However, the relationship of SBCs with postoperative complications remains understudied, and current surgical risk models underestimate risk among patients with significant SBC burden. METHODS: We conducted an observational study of Veterans undergoing elective colectomy included in the Veterans Affairs Surgical Quality Improvement Program (VASQIP). Structured data from the Veteran Health Administration Corporate Data Warehouse were used to identify 6 SBC phenotypes (mental health disorder, suicide risk, substance use, social isolation, housing instability, and food insecurity) across 3 preoperative ascertainment windows: ≤90 days, ≤365 days, and lifetime. The outcome was any 30-day VASQIP-defined postoperative complication. Multilevel logistic regression estimated associations between SBCs and complications. RESULTS: Among 38,188 Veterans undergoing colectomy between 2009 and 2025, the median age was 66 years; 5% were female; 30% were non-white; and 48% had cancer. Mental health disorder, social isolation, or substance use were each associated with an 8%-40% increase in the odds of a complication across all ascertainment windows. Within the most proximal window, risk of complication increased as SBC burden increased: 16% increased odds with 1 SBC (aOR 1.16, 95% CI: 1.09-1.23) and 80% increased odds with 4-6 SBCs (aOR 1.80, 95% CI: 1.32-2.36). CONCLUSIONS: In a national Veteran cohort, SBCs were associated with postoperative colectomy complications. The strongest associations were observed with SBCs ascertained within the 90-day window, and the odds increased in a dose-response relationship with increasing SBC burden.