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Mortality After Pediatric Cardiac Surgery in Patients From Disadvantaged Neighborhoods
Mitchell C Haverty1, Rittal Mehta1, Dita Niraula1
1Division of Cardiovascular Surgery, Department of Pediatrics, Children's National Hospital, Washington, DC.
Annals of Thoracic Surgery Short Reports
|January 10, 2025
Summary
Patients from disadvantaged neighborhoods face higher surgical mortality due to factors like surgical complexity and genetic abnormalities. Addressing these disparities requires rethinking preoperative care for congenital heart disease patients.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Congenital Heart Disease
Background:
- Disadvantaged socioeconomic status is linked to worse outcomes in congenital heart disease (CHD) patients.
- This study investigated individual and neighborhood factors affecting short-term surgical outcomes in CHD patients.
- The research aimed to identify drivers of healthcare disparities in this population.
Purpose of the Study:
- To examine the association between socioeconomic status and surgical outcomes in patients with congenital heart disease.
- To identify individual and neighborhood characteristics contributing to disparities in surgical outcomes.
- To explore potential drivers of adverse outcomes in disadvantaged patient groups.
Main Methods:
- A single-center retrospective analysis of cardiovascular surgery patients from 2007-2022 in the District of Columbia metropolitan area.
- Neighborhood socioeconomic status was assessed using the Child Opportunity Index, comparing disadvantaged and advantaged areas.
- A stepwise multivariable model analyzed operative mortality and major surgical complications.
Main Results:
- Half of the 2562 patients (49.6%) lived in disadvantaged neighborhoods.
- While bivariable analysis suggested higher mortality in disadvantaged groups (OR, 1.52; P=.054), this was not significant in multivariable analysis (OR, 0.91; P=.73).
- Surgical factors including The Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery (STAT) category, patient size, and genetic abnormalities predicted increased operative mortality and major complications.
Conclusions:
- Operative mortality in disadvantaged populations is influenced by nonmodifiable factors like surgical complexity, patient size, and genetic abnormalities.
- These findings highlight the need to address socioeconomic disparities in congenital heart disease care.
- Reconceptualizing preoperative patient care is crucial for mitigating these disparities.
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