Social determinants of health refer to the conditions, lived experiences, and exposures associated with the life of an individual, specifically in regard to the confluence of their impact on that individual’s overall health.1 These social determinants can also impact surgery outcomes.2
Authors Devin and Shaffer propose a comprehensive list of social determinants which affect surgery outcomes. These include socioeconomic status, race and discrimination, education attainment, social and community-based support, access to nutrition, physical environment, and the healthcare system with which one interacts.2 Socioeconomic status affects the likelihood one is to seek immediate care and intervention for a medical issues as well as one’s ability to pay for treatment.2 In a study looking at 951 patients who underwent lumbar spine surgery, after controlling for age, American Society of Anesthesiologists physical status classification, and surgery type, reported financial strain was found to be associated with a longer, in-hospital length of stay (β=14.3; P=0.022).3
Race also serves as a social determinant which influences surgery outcomes. In a 2006 study looking at differences in postoperative mortality by race for 8 different cardiovascular and cancer operations, authors found that Black patients, when compared to their White counterparts, had higher crude mortality rates for 7 of the 8 operations.4 Within these 7 operations, the increased risk of mortality ranged from 23% (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.18-1.29) for coronary artery bypass grafting to 61% (OR 1.61; 95% CI 1.28-2.03) for esophagectomy.4 Authors ultimately attributed the difference in mortality by race to the different hospitals patients sought care at.4
Additionally, health literacy is an important factor which, when lacking, can result in increased postoperative complications.5 In a 2022 retrospective cohort study, in adjusted analyses, limited health literacy was associated with two-fold risk of overall complications (OR 2.03; 95% CI 1.01-4.08; P=0.046).5 Similarly, an additional study looked into the influence of education on functional scores for patients 6 months after from a total knee arthroplasty for knee osteoarthritis. In this study, data suggested that those with high education (i.e., >12 years of education, college degree or above) had greater 6 month postoperative functional scores when compared with those scores of postoperative patients in the low education (i.e., ≤6 years of education, primary school or below; P<0.001) and medium education (i.e., 7-12 years of education, including junior high school, high school, technical secondary school, or vocational school; P<0.001) groups.6
In conclusion, social determinants of health refer to the experiences, exposures, and characteristics of one’s identity and lived experiences which are attributable to the modifications of one’s overall health. Important factors include socioeconomic status, race and ethnicity, education, support, and access to medical institutions providing care. These social determinants also impact surgery outcomes, with some being associated with increased risk of numerous postoperative complications. Thus, it is important to consider all aspects of a patient’s identity and lived experiences when assessing the risk of postoperative complications.
References
1. Office of Disease Prevention and Health Promotion. Social determinants of health. Off Dis Prev Health Promot. Published online 2025. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
2. Devin CL, Shaffer VO. Social Determinants of Health and Impact in Perioperative Space. Clin Colon Rectal Surg. 2023;36(3):206-209. doi:10.1055/s-0043-1761155
3. Holbert SE, Andersen K, Stone D, Pipkin K, Turcotte J, Patton C. Social Determinants of Health Influence Early Outcomes Following Lumbar Spine Surgery. Ochsner J. 2022;22(4):299-306. doi:10.31486/toj.22.0066
4. Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States. Ann Surg. 2006;243(2):281-286. doi:10.1097/01.sla.0000197560.92456.32
5. Theiss LM, Wood T, McLeod MC, et al. The association of health literacy and postoperative complications after colorectal surgery: A cohort study. Am J Surg. 2022;223(6):1047-1052. doi:10.1016/j.amjsurg.2021.10.024
6. Cheng Y, ZheYiKen JANE, Kang X, He W. The impact of educational level on rehabilitation outcomes after total knee arthroplasty in patients with knee osteoarthritis: A retrospective study. Curr Probl Surg. 2025;63:101693. doi:10.1016/j.cpsurg.2024.101693
