Social Vulnerability Is Positive Correlated with Number of Cancelled Postoperative Appointments following Pituitary Adenoma Resection

Introduction: There is a need to identify factors impacting postoperative outcomes of neurosurgical patients, and social determinants of health (SDOH) disparities are some of many such factors. It is well established that these factors play a large role in health outcomes, including decreased access to healthcare, increased financial burden, and increased morbidity and mortality. Furthermore, some studies have found that SDOH disparities can independently predict a prolonged hospital length of stay and 90-day mortality in brain tumor patients, and a study published from our institution showed that this same trend of prolonged length of stay persisted in a socioeconomically disadvantaged population following pituitary adenoma resection. Given that our institution operates out of the Bronx, home to one of the most socially vulnerable populations in this country, we have the unique opportunity to examine the impact of social vulnerability on postoperative outcomes in neurosurgical patients.

Objective: In this single-center study, we aimed to determine if increased social vulnerability was associated with more frequent cancelled follow-up appointments after pituitary resection.

Methods: We conducted a retrospective chart review of patients treated for pituitary adenoma between 2017 and 2023 at a single academic tertiary care center. A total of 154 patients were included in this study. By race, 79 (51.2%) patients were Black, 14 (9.1%) patients were White, 2 (1.3%) were Asian, and 49 (31.8%) were other or declined to respond. By ethnicity, 51 (33.1%) patients were Hispanic/Latino, 86 (55.8%) were non-Hispanic/Latino, and 17 (11.0%) declined to respond. Social Vulnerability Index (SVI) scores were collected for each patient based on home address, drawn from a series of metrics from 2020 census data. The four major metrics included in our study were socioeconomic status (SES), household composition/disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). These data were composited into an overall SVI calculation, and for each category, a higher value indicated a greater vulnerability.

Results: In our patient population, mean overall SVI was 0.81 (95% CI [0.78, 0.85]), mean SVI for SES was 0.71 (95% CI [0.67, 0.76]), mean SVI for HCD was 0.77 (95% CI [0.73, 0.81]), and mean SVI for MSL was 0.80 (95% CI [0.76, 0.83]). The number of cancelled appointments following tumor resection was positively correlated with overall SVI (r ² = 0.027; p = 0.045* [n = 147]), SVI for SES (r ² = 0.027; p = 0.047* [n = 147]), and SVI for MSL (r ² = 0.026; p = 0.049* [n = 147]). There was no correlation between the number of cancelled appointments and SVI for HCD (r ² = 0.020; p = 0.088 [n = 147]) and SVI for HTT (r ² = 0.010; p = 0.231 [n = 147]).

Conclusion: In our study, we showed that increased vulnerability was correlated with a greater number of cancelled appointments following pituitary tumor resection, both in the overall SVI and individually across multiple domains that included socioeconomic status, minority status, and language. More studies need to be done that further assess and address barriers to care for the socially vulnerable.

Publication History

Article published online:
07 February 2025