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Social determinants of health and surgical outcomes of minimally invasive radical prostatectomy: a national population-based study

Prostate Cancer and Prostatic Diseases volume 28, pages 767–772 (2025)Cite this article

Subjects

Abstract

Background

Socioeconomic determinants of health (SDOH) are often unvalued during surgery risk stratification; hence, they might be a major source of disparity that can jeopardize outcomes related to urological surgery. The aim of our study is to evaluate the impact of SDOH on postoperative outcomes following minimally invasive radical prostatectomy (MIRP).

Methods

Patients who underwent MIRP between 2011 and 2021 were retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify patient’s characteristics, postoperative complications and SDOH. Outcomes were compared using multivariable regression models.

Results

Overall, 100,035 patients (mean age = 63.24 ± 7.07) underwent MIRP. The 60-day postoperative complication rate was 18%. Approximately 6% of patients reported at least one SDOH at baseline. SDOH were associated with higher odds of 60-day postoperative complications (OR:1.24, 95% CI:1.15–1.34), including urinary tract infection (OR:1.32, 95% CI:1.20–1.45) and acute kidney injury (OR:1.31, 95% CI:1.00–1.39). Postoperative urethral stricture (OR:1.37, 95% CI:0.92–1.98) did not reach statistical significance at multivariable analysis.

Conclusions

Patients with SDOH have a significantly higher risk of postoperative complications following MIRP, especially urinary infection and acute kidney injury. These findings are multifactorial and should prompt identifying measures that might help prevent this large-scale phenomenon.

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Fig. 1: Timeline and temporal trends in MIRP procedures.

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Data availability

The data presented in this study are available on request from the corresponding author due to privacy policies.

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Author notes

  1. These authors contributed equally: Spencer M. Mossack, Antonio Franco.

Authors and Affiliations

  1. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Spencer M. Mossack, Antonio Franco, Daniel F. Roadman, Morgan R. Sturgis, Angelo Orsini, Gabriele Bignante, Francesco Lasorsa, Christopher L. Coogan, Edward E. Cherullo & Riccardo Autorino

  2. Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, Italy

    Antonio Franco & Cosimo De Nunzio

Authors
  1. Spencer M. Mossack
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  2. Antonio Franco
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Contributions

Conception and design: Autorino, Franco; Acquisition of data: Franco, Orsini, Bignante, Lasorsa; Statistical analysis: Mossack, Roadman; Interpretation of the data: Sturgis, Bignante, Roadman, Coogan, Cherullo; Drafting of the manuscript: Mossack; Critical revision of the manuscript for important intellectual content: Franco, De Nunzio, Autorino; Supervision: Autorino; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Mossack, Sturgis, Orsini, Lasorsa, De Nunzio, Coogan, Autorino; All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Riccardo Autorino.

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The authors declare no competing interests.

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As a secondary analysis of deidentified data, the study was granted exempt status from institutional board review.

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Mossack, S.M., Franco, A., Roadman, D.F. et al. Social determinants of health and surgical outcomes of minimally invasive radical prostatectomy: a national population-based study. Prostate Cancer Prostatic Dis 28, 767–772 (2025). https://doi.org/10.1038/s41391-024-00913-0

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