Social Determinants of Health in Endoscopic Anterior Skull Base Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND

Social determinants of health (SDOH) have been extensively studied in multiple fields, but studies in endoscopic anterior skull base surgery are limited. Our systematic review examines studies analyzing SDOH and their association with endoscopic anterior skull base surgery outcomes.

METHODS

This December 2023 systematic review surveyed literature via Embase, Web of Science, MEDLINE, and CENTRAL using predefined syntax analyzing SDOH in endoscopic anterior skull base surgery outcomes. Two independent authors screened the titles, abstracts, and full text for eligibility of inclusion, with a third author resolving any conflicts that arose.

RESULTS

Among 18 studies from 2015 to 2023, the most common SDOH included were insurance status (67%, n = 12), race and ethnicity (61%, n = 11), and SES (50%, n = 9). Common outcomes included rate of postoperative complications (67%, n = 12), length of stay (56%, n = 10), and 30-day readmissions (39%, n = 7). Asian patients had higher odds of 30-day readmission compared to White patients (OR = 1.30, 95% CI: 1.04-1.62, p = 0.02). Black patients had an increased risk of postoperative diabetes insipidus compared to White patients (RR = 1.32, 95% CI: 1.09-1.59, p < 0.01). Medicaid patients had higher odds for 30-day readmission (OR = 1.30, 95% CI: 1.08-1.56, p < 0.01) and greater risk of postoperative diabetes insipidus (RR = 1.25, 95% CI: 1.02-1.52, p = 0.03) compared to private insurance patients.

CONCLUSIONS

Several studies indicate that race and insurance status significantly influence rates for readmission and postoperative complications in endoscopic anterior skull base surgery. The heterogeneity of other SDOH suggests further research to consolidate the findings and explore potential links explaining the observed variations.

LEVEL OF EVIDENCE: 3.