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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes
Amy R Kolwaite1, Johnathan A Edwards2, Melinda Higgins1
1Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
Insights
The Child Opportunity Index (COI) impacts hospital length of stay after congenital heart surgery, but not mortality or readmission. Understanding COI can guide interventions to improve health equity in pediatric cardiac care.
Area of Science:
- Pediatric Cardiology
- Social Determinants of Health
- Health Equity
Background:
- The Child Opportunity Index (COI) is a comprehensive measure of social determinants of health.
- Understanding the impact of the COI on patient outcomes following congenital cardiac surgery is crucial for improving care and addressing health disparities.
Purpose of the Study:
- To assess the relationship between the Child Opportunity Index (COI) and patient-specific outcomes after congenital cardiac surgery.
- To investigate the association of specific COI domains with outcomes in pediatric cardiac surgery patients.
Main Methods:
- Retrospective chart review of patients undergoing congenital heart disease surgery (2010-2020).
- Geocoding patient addresses to census tracts for COI mapping.
- Utilizing descriptive statistics, univariable, and multivariable regression analyses to determine associations between COI and outcomes.
Main Results:
- Postoperative hospital length of stay was significantly associated with COI in both univariable and multivariable models (P < .001).
- While mortality/morbidity showed a univariable association with COI (P = .008), this was not significant in the multivariable model (P = .39).
- No significant association was found between COI and 30-day readmission rates.
Conclusions:
- The Child Opportunity Index (COI) is linked to longer hospital stays but not all adverse outcomes in pediatric congenital heart surgery patients.
- Recognizing the influence of COI on cardiac surgery outcomes can inform targeted interventions to enhance health equity.
- Further research into specific COI domains may yield more precise insights for improving patient care and reducing disparities.
Objective:
To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia.
Study Design:
In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes.
Results:
Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P = .008), but not the multivariable regression model (P = .39). Postoperative hospital length of stay was significantly associated with COI (P < .001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (P < .094) and multivariable (P = .49) models.
Conclusion:
COI is associated with postoperative hospital length of stay but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.
