B. A. Brock1, B. Smith1, L. Wood1, R. Heng1, C. Hodges1, B. Jones2, W. Oslock1, N. English3, R. Hollis1, D. Gunnells1, D. Chu1 2University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA 3University of Cape Town, Department Of General Surgery, Cape Town, WC, South Africa 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Social determinants of health (SDOH) affect surgical outcomes. The PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) is a validated and comprehensive instrument utilized to evaluate patients’ SDOH risk. However, there is little known about the associations between the PRAPARE and surgical outcomes. Therefore, the aim of this study was to evaluate the association of the PRAPARE and its components to surgical outcomes including readmission and length-of-stay (LOS) after colorectal surgery.
Methods: This was a retrospective cohort study using PRAPARE survey data collected prospectively from patients undergoing elective colorectal surgery from 8/2021 to 7/2023 (n=225). Survey data was linked to our institutional ACS-NSQIP database. The PRAPARE survey was administered as part of a larger 88-item survey that was created using the modified Delphi method to assess 24 different SDOHs at the 5 socioecological levels. The PRAPARE included 19 of the original 21 items across 5 domains (Personal Characteristics, Family and Home, Money and Resources, Social and Emotional Health, and Optional Additional Questions). A modified scoring system was used with possible question values ranging from 1-16 points with a total possible score of 46. The primary outcome was 30-day readmissions and the secondary outcome was length-of-stay.
Results: A total of 225 patients were surveyed with a median age of 60 (IQR 49.1-67.9), of which 50.6% were male. In this cohort, 28.4% of patients were Black and 71.6% were White. Readmitted patients had a higher median PRAPARE score, which is associated with higher SDOH risk. There was no statistically significant association between overall PRAPARE score and readmission rate, with the median PRAPARE score for non-readmissions being 5 (IQR 4.0-6.0) and for readmission being 6.5 (IQR 4.0-7.5) (p=0.11). Three components of the PRAPARE had statistically significant associations with readmission rates. Under Personal Characteristics, non-white patients made up 0% of non-readmissions versus 50% of readmissions (p<0.01). Under Social and Emotional Health, patients with decreased social support made up 7.95% of non-readmissions versus 33.33% of readmissions (p=0.01). Lastly under Optional Additional Questions, patients who felt unsafe made up 0% of non-readmissions versus 18.18% of readmissions (p<0.01). While stress within Social and Emotional Health was not statistically significant (p=0.37), patients with more stress made up 61.5% of non-readmissions but 75% of readmissions. LOS was not associated with any component of PRAPARE.
Conclusion: While the overall PRAPARE score was not associated with readmission or length-of-stay, specific components of PRAPARE were significantly associated with readmissions, including non-white identity, decreased social support, and decreased safety. Future research should focus on these areas to develop interventions to improve social support and safety.