(0655) How Social Determinants of Health Impact Endoscopic Anterior Skull Base Surgery Outcomes: A Systematic Review

Introduction: Of modifiable health related factors, 80-90% are categorized as social determinants of health (SDOHs). While SDOHs have been extensively studied in multiple fields, studies in endoscopic anterior skull base surgery are limited. Our systematic review examines studies analyzing SDOHs and their association with endoscopic anterior skull base surgery outcomes.

Methods: Our December 2023 systematic review surveyed literature from 1946 to 2023 that analyzed SDOHs in endoscopic anterior skull base surgery outcomes. Studies were searched via Embase, Web of Science, MEDLINE, and CENTRAL using predefined syntax. Outcomes searched included length of stay, 30-day readmission, cost of care, and postoperative complication rates. Data extracted included insurance status, race, socioeconomic status (SES), patient’s residence, smoking history, and hospital type.

Results: Our analysis included 19 studies from 2009 to 2023. The most common SDOHs included in the studies were insurance status (68%, n = 13), followed by race and ethnicity (63%, n = 12) and SES (47%, n = 9). Outcomes evaluated included rate of postoperative complications (58%, n = 11), followed by length of stay (53%, n = 10), 30-day readmissions (37%, n = 7), and cost of care (26%, n = 5). Race, ethnicity, and insurance status were consistently associated with adverse outcomes. Black, Asian, and Hispanic patients had higher rates of prolonged length of stay, increased cost of care, and increased rates of postoperative complications compared to White and non-Hispanic patients. Medicare and Medicaid patients had increased rates of prolonged length of stay and postoperative complications compared to private insurance patients.

Conclusions: Several studies indicate race, ethnicity, and insurance status significantly influence patient outcomes in endoscopic anterior skull base surgery. However, the heterogeneity of other SDOHs suggests further research to consolidate the findings and explore potential links explaining the observed variations.