Preadmission Testing in the Context of Social Determinants of Health: A Narrative Review of Gaps, Challenges, and Opportunities for Equitable Perioperative Care.

Preadmission testing (PAT) represents a critical step in perioperative care, designed to optimize readiness and minimize same-day cancellations, yet its traditional model assumes patients can reliably complete laboratory testing, specialist consultations, and preoperative instructions without structured support. A growing body of evidence demonstrates that social determinants of health (SDOH), including limited health literacy, language barriers, transportation difficulties, housing instability, digital access inequities, and work or caregiving responsibilities, directly affect patient readiness and outcomes. Studies confirm that transportation costs, housing insecurity, and unstable caregiving arrangements increase missed appointments, while patients with limited English proficiency or low health literacy are at greater risk of miscommunication, misunderstanding instructions, and adverse perioperative outcomes. Digital divides further undermine the potential benefits of virtual PAT models, with lower-income and older patients less likely to access or use video-based visits. Interventions such as frailty screening, patient navigation, professional interpreter integration, plain-language education, e-health modules, and structured prehabilitation programs have shown promise in improving comprehension, satisfaction, readmissions, and even survival. However, these approaches remain inconsistently implemented and often limited to single-center initiatives. This review synthesizes current literature linking SDOH to perioperative readiness and highlights evidence-based strategies that can be integrated into PAT workflows. Embedding equity-focused screening, advocacy, flexible scheduling, hybrid digital options, and tailored education into PAT can help transform it from a potential source of inequity into a consistent gateway for safer, more inclusive surgical care.