Date of Conferral

2021

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Vasileios Margaritis

Abstract

Decreasing surgical morbidity and improving surgical safety is a public health priority. With same-day or early hospital discharge after surgery, knowledge about social determinants of health (SDOH) impact on surgical morbidity is vital for surgical safety improvement. This study’s aim was to evaluate SDOH association with surgery-related morbidity after colorectal surgery in an adult population. This quantitative cross-sectional study used New York Statewide Planning and Research Cooperative System (SPARCS) secondary data from 2006 ⁠–2016 on 130,731 patients linked to SDOH. Dependent variables were anastomotic leak (AL), surgical site infection (SSI), Not SSI related, and overall complications (COMPL) within 30 days after surgery. The WHO conceptual model for SDOH was used to explain the study outcomes as social production. Bivariate analysis (chi-square) and binomial logistic regression were used. The results showed: social vulnerability (SVI) increased the odds for AL, SSI, Not SSI, and COMPL. Socioeconomic status vulnerability increased odds for SSI, Not SSI, and COMPL. African Americans had higher odds for AL, SSI, and COMPL. Both “Limited English All Households” ≤ 8.2 % and “Associate degree” >8.8% on zip code decreased the odds for AL, SSI, Not SSI, and COMPL. SDOH are associated with surgical morbidity and should be considered in patients’ surgical care. The study results can be utilized for positive social change by professionals and programs, to develop strategies and policies considering SDOH to decrease surgical morbidity, improve surgical safety; and to address upstream SDOH to improve surgical care by reducing the racial disparity gap, and provide more equitable healthcare, ultimately improving the population health.

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