Eloise Turner

Abstract

Background: Socioeconomic deprivation is a well-established determinant of cancer incidence, stage at presentation, and long-term survival. However, its influence on short-term surgical outcomes in head and neck oncology remains unclear. As major resections with microvascular reconstruction carry significant peri-operative risk, understanding whether socioeconomic status affects early postoperative outcomes is essential for designing equitable surgical pathways. This study explores whether deprivation impacts complication rates, return to theatre, and length of stay within a publicly funded healthcare system where care is delivered independent of socioeconomic position.

Methods: A retrospective cohort study was conducted over 3.5 years at a single UK head and neck cancer centre. Demographic, clinical, behavioural, and peri-operative variables were collected alongside area-level socioeconomic indicators derived from the Index of Multiple Deprivation (IMD) and its subdomains. Postoperative complications were coded using predefined clinical criteria. Appropriate non-parametric and categorical statistical tests were used to assess associations between socioeconomic measures and postoperative outcomes.

Results: Across all major IMD domains, including income, employment, education, health and disability, and crime, socioeconomic deprivation was not associated with increased postoperative complications, flap failure, or return to theatre. Only the living environment domain showed a marginal association (p = 0.049), suggesting a possible but small effect of environmental conditions on early recovery. As expected, patients with complications experienced significantly longer hospital stays (median 20 vs 12 days, p < 0.001). No other socioeconomic domain demonstrated a significant relationship with adverse outcomes.

Conclusion: In this cohort, socioeconomic deprivation did not significantly influence short-term postoperative outcomes following major head and neck cancer surgery. These findings highlight the strength of equitable, standardised pathways within healthcare systems, where universal access and multidisciplinary peri-operative care appear to mitigate the socioeconomic gradients. The results suggest that when a system is genuinely built for equality, it is possible to achieve fair surgical outcomes across all socioeconomic groups. Subtle effects related to environmental deprivation warrant further study, as do potential long-term socioeconomic influences on recovery, rehabilitation, and quality of life.

Implications: This study reinforces the importance of incorporating socioeconomic context into surgical research while demonstrating the capacity of universal healthcare systems to deliver equitable early outcomes. Future multicentre work with larger cohorts and long-term follow-up is needed to better understand how socioeconomic disadvantage may shape recovery beyond the immediate postoperative period.