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Published on: March 27, 2018
Low socioeconomic status adversely influences outcomes after coronary artery bypass grafting
Paige E Brlecic1, Christopher B Sylvester2, Katie J Hogan2
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, Tex.
Insights
Patients with lower socioeconomic status (SES) face higher mortality and readmission risks following coronary artery bypass grafting (CABG). This study highlights significant disparities in outcomes based on SES after this major cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Health Economics
Background:
- Socioeconomic status (SES) is a known determinant of health outcomes.
- Limited data exist on the impact of SES on readmission rates after coronary artery bypass grafting (CABG).
- Understanding these disparities is crucial for improving post-surgical care and resource allocation.
Purpose of the Study:
- To analyze the influence of SES on readmission, resource utilization, and mortality after CABG.
- To assess risk-adjusted outcomes in a large national cohort.
- To identify specific patient and hospital factors associated with SES.
Main Methods:
- Utilized the Nationwide Readmissions Database (NRD) for isolated CABG cases from 2016-2018.
- Derived SES (low, middle, high) using ICD-10-CM codes, demographics, and neighborhood data.
- Employed multivariable analysis to evaluate the effect of SES on risk-adjusted outcomes.
Main Results:
- Low SES patients (25.6%) were more likely to be female, younger, from rural areas, and urgently admitted.
- Low SES was associated with higher comorbidity scores and less frequent treatment at teaching hospitals.
- Risk-adjusted analysis revealed significantly higher in-hospital mortality (OR 1.464), longer length of stay, and increased odds of 30-day (OR 1.229), 90-day (OR 1.281), and annual readmission (HR 1.234) for low SES patients compared to high SES patients.
Conclusions:
- Patients with low SES experience significantly higher adjusted odds of mortality and readmission after CABG.
- These findings underscore socioeconomic disparities in cardiovascular surgical outcomes.
- Targeted interventions may be necessary to mitigate these adverse outcomes in vulnerable populations.
Objectives:
Although socioeconomic status (SES) is believed to affect patient outcomes after coronary artery bypass grafting (CABG), readmission data are sparse. In a national cohort, we analyzed the influence of SES on readmission, resource utilization, and mortality after CABG.
Methods:
We queried the Nationwide Readmissions Database to identify patients who underwent isolated CABG from January 2016 through December 2018. We derived low, middle, and high SES from International Classification of Diseases, 10th Revision, Clinical Modification codes, patient demographics, and neighborhood-level factors. The effect of SES on risk-adjusted outcomes was assessed with multivariable analysis.
Results:
Of 523,042 patients who underwent CABG, the 134,039 (25.6%) with low SES were more likely than patients with middle (n = 305,572 [58.4%]) or high SES (n = 83,431 [16%]) to be female, younger, from rural areas, and admitted urgently. Patients with low SES were also less likely to be treated at teaching hospitals and had higher Elixhauser comorbidity scores (P < .001 for all). After risk adjustment, patients with low SES had 46% greater odds of in-hospital mortality at the index operation (odds ratio, 1.464; 95% CI, 1.299-1.650) than patients with high SES. Patients with low SES had the longest index hospital length of stay (P < .001). Low SES was associated with greater odds of readmission at 30 days (odds ratio, 1.229; 95% CI, 1.170-1.292), 90 days (odds ratio, 1.281; 95% CI, 1.223-1.341), and within a calendar year (hazard ratio, 1.234; 95% CI, 1.193-1.278) than high SES.
Conclusions:
Patients with low SES have greater adjusted odds of mortality and readmission after CABG than patients with high SES.
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