Identifying Social Determinants of Health Associated with Same-Day Cancellations for Urologic Surgery.

Objective: To identify upstream factors associated with unplanned urologic surgery cancellations at a safety-net hospital.

Methods: A retrospective cohort study of patients (age >18) scheduled for urologic surgery operating room procedures between January 2021 and June 2023 at an urban county hospital was conducted. Patient demographics, social determinants of health, and clinical data were abstracted from electronic health records. The primary outcome was unplanned day-of-surgery cancellations. Continuous and categorical variables were analyzed using Mann-Whitney and chi-square, respectively. A multivariable logistic regression model was used to assess the effect of variables on predicting cancellations.

Results: Out of 778 patients, 136 (17.5%) had a day-of-surgery cancellation. Multivariable model revealed wheelchair use (OR 3.17 [1.78,5.63], p<0.001), Black race (OR 2.62 [1.38,4.98], p=0.003), history of incarceration (OR 2.00 [1.04,3.83], p=0.037, higher rates of prior missed appointments (OR 1.02 [1.00,1.04], p=0.047), and assigned primary care provider (OR 0.58 [0.37,0.89], p=0.014) as statistically significant.

Conclusions: Day-of-surgery cancellations negatively affect patient outcomes, disrupt hospital workflow, and increase care costs. This study is the first to examine a more comprehensive list of patient-specific factors in relation to day-of-surgery cancellations. By providing further insight into factors associated with cancellations, our findings set the stage for targeted interventions to improve healthcare quality and equity for patients' access to urologic surgery.