Social determinants of health Z-codes and postoperative outcomes after colorectal surgery: A national population-based study


      • Social determinants of health were measured using ICD 9 and 10 codes.
      • 5% of patients undergoing colorectal surgery reported a social determinant of health.
      • Social determinants of health were associated with postoperative outcomes.



      We sought to evaluate the impact of social determinants of health (SDOH) on postoperative outcomes following colorectal surgery.


      This retrospective cohort study used PearlDiver-Mariner, an all-payer insurance claims database. Patients who underwent colectomy or proctectomy between 2010 and 2020 were included. SDOH were identified using International Classification of Diseases diagnosis codes. Outcomes were compared using multivariable regression models.


      The 30-day postoperative complication rate among 333,387 patients (mean age, 59 years; 58% female) was 27%. Approximately 5% of patients reported at least one SDOH at baseline. SDOH were not associated with length of stay but were associated with higher odds of 30-day postoperative complications (OR:1.16, 95% CI:1.12–1.20), including urinary tract infection (OR:1.27, 95% CI:1.20–1.35) anastomotic leak (OR:1.22, 95% CI:1.16–1.28), pneumonia (OR:1.19, 95% CI:1.11–1.27), deep vein thrombosis (OR:1.13, 95% CI:1.02–1.23), sepsis (OR:1.12, 95% CI:1.07–1.18), disruption of wound (OR:1.12, 95% CI:1.03–1.21), and acute kidney injury (OR:1.04, 95% CI:0.99–1.10).


      SDOH Z-codes were associated with worse postoperative complications following colorectal surgery and may help target high-risk patients.


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