Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children

Dr. Megan Read Ivaturi from Nationwide Children's Hospital discusses a study on how social determinants of health influence the choice of urinary reconstruction in children. The research, a single-institution retrospective study of 208 patients, reveals that while insurance type and childhood opportunity index had no impact, factors like food insecurity, missed appointments, and unmarried parents were associated with incontinent reconstruction. Interestingly, patients traveling from out of state were more likely to receive continent diversions. This highlights the critical role social stability and access to follow-up play in surgical decision-making and sustainable patient care. Kristine L Griffin, Jeremy M Lun, Alexandra Bain, Shruthi Srinivas, Ihab Halaweish, Richard J Wood, Daniel DaJusta, Molly E Fuchs Objective: To examine if social determinants of health (SDH) are associated with the type of urological reconstruction performed in patients with neurogenic bladder secondary to myelomeningocele and anorectal malformations. Methods: A single-institution retrospective review was performed in children with incontinent urinary reconstruction (IUR) or continent urinary reconstruction (CUR) and a diagnosis of myelomeningocele, anorectal malformation, or spinal cord pathology from years 2014-2021. Demographic, clinical, and SDH data were collected and compared to reconstruction type. Categorical variables were analyzed via Fisher Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend. Results: From 2014 to 2021, 208 patients underwent urological reconstruction. Patients had a diagnosis of anorectal malformation (32.2%), myelomeningocele (30.8%), spinal cord pathology (18.8%), other diagnosis (18.3%), or cloacal exstrophy (4.8%). Of the cohort, 154 (74%) had a CUR, and 54 (26%) underwent IUR. Median age at reconstruction was higher in those who underwent CUR (6.7years [IQR 5.3, 9.8]) than for IUR (5.6 [IQR 1.5, 10.5]) (P=.01). There was no difference between insurance type for IUR vs CUR (P=.11). There was no association between Child Opportunity Index (COI) and reconstruction type (P=.5). Patients who underwent IUR were more likely to have experienced food insecurity (P=.02), missed at least one appointment (P=.02), or have unmarried parents (P=.03). Those who lived out of state more often pursued CUR (P=.01). Conclusion: There was an association between SDH and type of urologic reconstruction performed in pediatric patients. Social factors must be considered in preoperative planning for urinary reconstruction.