# The Impact of Racial Disparities and Social Determinants of Health on Postoperative Outcomes After Pancreaticoduodenectomy (Whipple Procedure)

## TL;DR

This study examines how race and social factors affect complications after a complex pancreatic surgery, finding that Black patients with social disadvantages had slightly higher risks.

## Contribution

The study uniquely evaluates the combined impact of race and social determinants on surgical outcomes in pancreatic surgery.

## Key findings

- Complication rates were similar across most racial groups, but lower in Asian patients.
- Social determinants of health were linked to higher complication rates in all groups.
- Black patients with social disadvantages had a statistically significant increase in complications compared to White patients with similar risks.

## Abstract

Background: Pancreatectomy, particularly the Whipple procedure, is the standard surgical treatment for resectable pancreatic head tumors but carries high complication rates. Evidence suggests that race and social determinants of health (SDOH) may influence postoperative outcomes, but these disparities remain underexplored in pancreatic surgery.

Objective: This study aimed to evaluate the impact of race and SDOH on postoperative complication rates following pancreatectomy, using a large electronic health record dataset.

Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients undergoing Whipple procedures were identified by the Current Procedural Terminology (CPT) code 48150. Postoperative complications were defined by ICD-10 codes T81 and K91. SDOH were identified using ICD-10 Z55-Z65 codes. Patients were stratified by race (White, Black, Asian, Hispanic) and SDOH status. Primary outcomes compared complication rates across racial groups. Secondary outcomes evaluated the relative risk (RR) of complications within each racial group by SDOH status, benchmarked against White patients.

Results: Among 11,546 patients, complication rates did not significantly differ between White (3649/9027, 40.4%), Black (457/1197, 38.2%), or Hispanic (349/874, 39.9%) patients, but were lower in Asian patients (157/448, 35.0%; p = 0.0234). The presence of SDOH was associated with higher complication rates across all groups. Only Black patients demonstrated a statistically significantly greater relative increase in complication risk due to SDOH compared with White patients (RR 1.52 vs. 1.51; Z = -0.19; p < 0.0001). No significant disparities related to SDOH were observed in the Hispanic or Asian groups.

Conclusions: In this multicenter analysis of pancreatectomy (Whipple procedures), complication rates were high across all racial groups, and race alone, both with and without adjustment for social determinants of health, was not a consistent predictor of outcomes. Black patients with documented SDOH had a small but statistically significant increase in complications compared to White patients with similar social risk, suggesting a modest impact that warrants further investigation. These findings highlight the importance of considering both race and SDOH when addressing disparities in surgical outcomes.