Role of Social Determinants of Health in Skull Base Surgery

Introduction: Socioeconomic disadvantage, environmental factors, and other social determinants of health (SDOH) have been increasingly investigated for their associations with outcomes in variety of health conditions, including those in otolaryngology.
The aim of this study is to explore the role of SDOH on symptom-related quality-of-life (QoL) and complications in patients undergoing transnasal endoscopic pituitary surgery.

Methods: Cross-sectional study of all patients who underwent endoscopic endonasal pituitary surgery between August 2020 and April 2024 at an academic institution. Patients were asked to complete the SNOT-22 questionnaire at initial and follow up visits. Demographics and comorbidities were collected. SDOH were measured based on the national area deprivation indices (ADI) and insurance status. The effects of ADI on SNOT-22 score and complications were assessed using univariate and multivariable linear and logistic regressions for national ADI, hospital length of stay (LoS), and 30 days readmission while controlling for clinical factors.

Results: A total of 66 patients were included. Mean national ADI was 77.9 (SD=16.1). There was a trend toward an association between the national ADI and the psychological domain of the SNOT-22 scores on univariate [Coef 0.12, 95% CI (-0.01, 0.25)] and multivariate analysis [Coef 0.11, 95% CI (-0.01, 0.23)]. After controlling for age, gender, and intraoperative CSF leak, national ADI was significantly associated with increased hospital readmission within 30 days (OR=1.1, p=0.031).

Conclusions: SDOH as measured by national ADI maybe connected to worse patient-reported QoL in the psychological domain of the SNOT-22 scores and increases the odds of readmission after pituitary surgery. More studies with larger sample size are needed.