H. H. Smith T1, B. Smith1, L. Wood1, T. Wood1, M. Dye1, E. Lagrone1, S. Petrus1, G. Kennedy1, R. H. Hollis1, D. J. Gunnells1, D. I. Chu1 1UAB Heersink School of Medicine, Division Of Gastrointestinal Surgery, Birmingham, AL, USA
Introduction: Social determinants of health (SDOHs, e.g. insurance and income) are known to impact surgical disparities. Additionally, for those undergoing colorectal surgery, enhanced recovery programs (ERPs) have emerged as potential tools to reduce surgical disparities. Individual SDOHs (e.g. health literacy) have been shown to impact ERP adherence; however, the effects of additional SDOHs on ERP adherence remains unknown. Therefore, the aim of this study was to characterize the relationship between additional key SDOHs and ERP adherence among colorectal surgery patients.
Methods: This study was conducted from 8/2021 to 5/2022 at a single academic medical center. It was a prospective cohort study enrolling patients undergoing elective colorectal surgery under ERPs. A 75-item survey was developed using a modified Delphi method. It assessed 24 different SDOH at all 5 socioecological levels and was tested to ensure feasibility and acceptability. Finally, consenting participants were approached in the clinical setting to complete the survey on an electronic tablet. ERP adherence, clinical, and demographic data were collected through both chart review and an institutionally collected ACS-NSQIP database. The primary outcome of interest was >70% ERP protocol adherence. Measured SDOH were analyzed for their associations with ERP adherence.
Results: The cohort consisted of 206 patients with median age of 58.8 years (IQR 48-67), of which 52% were female and 28% were Black. Colectomy (58%) was the most common procedure followed by ostomy (15%) and APR procedures (8%). Overall, median Patient Activation Measure (PAM) score was 72 (IQR 52.9-90.2, max 100), trust as measured by the Wake Forest Trust scale was 22 (IQR 21-23, max 35), social support as measured by the NIH social support survey was 38 (IQR 32-40, max 40), discrimination as measured by the NIH Everyday Discrimination scale was 1(IQR 0-2, max 7), perceived stress as measured by the perceived stress scale was 5 (IQR 2-8, max 13), and the Protocol for Responding to and Assessing Patient Assets, Risks and Experiences (PRAPARE) risk score was 7.5 (IQR 7-9, max 14). Overall, 43% of the cohort was adherent to >70% of ERP components. No significant differences in PAM (76 vs. 69, p=0.32), trust (23 vs. 22, p=0.97), social support (39 vs. 38, p=0.2), discrimination (0 vs. 1, p=0.91), perceived stress (5 vs. 5, p=0.95), or PRAPARE risk factors (7 vs. 8, p=0.48) were seen between those adherent to >70% of ERP components and those non-adherent.
Conclusion: SDOHs including social support, patient activation, stress, discrimination, and other variables are measurable and vary among a colorectal surgery population. While not statistically significant, higher patient activation, trust, and social support and lower discrimination were observed in the ERP adherent group. Further investigation with larger sample size should be performed into the relationships between SDOH and ERP adherence.