Association Between Social Vulnerability and Clinical Outcomes After Proximal Aortic Surgery.

Area of Science:

• Cardiovascular Surgery
• Public Health
• Health Disparities

Background:

• Social vulnerability is a potential determinant of surgical outcomes.
• The Social Vulnerability Index (SVI) quantifies socioeconomic and environmental factors influencing health.
• Proximal aortic surgery carries significant risks, necessitating evaluation of all contributing factors.

Purpose of the Study:

• To investigate the association between preoperative Social Vulnerability Index (SVI) and outcomes following proximal aortic surgery.
• To determine if SVI independently predicts major adverse events or mortality after these procedures.

Main Methods:

• A single-center, SVI-stratified cohort study included 2002 patients undergoing primary proximal aortic surgery (1997-2023).
• SVI was calculated based on patient residential ZIP codes.
• Outcomes assessed included major adverse events (operative mortality, MI, stroke, reoperation, dialysis, tracheostomy) and all-cause mortality.

Main Results:

• Patients with higher SVI (≥0.75) presented with more comorbidities and non-elective surgery.
• SVI was not significantly associated with major adverse events (OR 1.09, P=0.80) or adjusted all-cause mortality (HR 1.29, P=0.17).
• Despite no independent association, patients with SVI ≥0.75 had the highest long-term all-cause mortality (16.2%, P=0.001).

Conclusions:

• Preoperative Social Vulnerability Index is not an independent predictor of early or late outcomes in proximal aortic surgery.
• The study highlights that while SVI doesn't independently affect surgical outcomes, vulnerable populations face higher long-term mortality, indicating potential systemic issues.
• Further research should explore interventions to mitigate disparities in care for socially vulnerable patients undergoing complex cardiovascular procedures.