Bridging the Gap: Assessing the Reporting of Social Determinants of Health Across a Decade of Randomized Controlled Trials in Plastic and Reconstructive Surgery.

Abstract

Social determinants of health (SDOH) play a critical role in shaping patient outcomes across medical and surgical disciplines. The present study evaluated randomized controlled trials (RCTs) across craniofacial reconstruction, breast reconstruction, and hand surgery to determine the frequency and patterns of SDOH reporting over the past decade. A systematic review was conducted according to the Preferred Reporting Items for Systematics and Meta-Analyses (PRISMA) statement guidelines. The PubMed and SCOPUS databases were queried for manuscripts based on RCTs published from 2014 to 2024. Manuscripts were published in English, involved participants at least 18 years old, and contained outcomes related to surgical interventions. The frequency of SDOH variables reported either solely within the manuscript or within the manuscript, and its tables were noted. Chi-squared and Fisher's exact tests were performed, and Pearson correlation coefficients were calculated ( P  < 0.05). In combined analysis, the most commonly reported SDOH variables were age (97.4%), sex/gender (80.4%), BMI/weight (47.2%), and smoking/tobacco use (25.3%). The least frequently reported SDOH variables were education level (4.3%), insurance (4.3%), socioeconomic status (1.9%), marital status (1.7%), and housing (0.0%). All variables were less likely to appear in Table 1 compared to the general manuscript. There were no significant correlations observed between the percentage of RCTs reporting SDOH measures and year of publication or journal impact factor. Despite the well-established impact of SDOH on health outcomes, the present findings highlight a persistent underreporting of these factors in plastic and reconstructive surgery trials. Future RCTs should prioritize the standardized inclusion of SDOH variables to enhance the generalizability of findings and inform more equitable surgical care.