Association of socioeconomic disadvantage with operative outcomes for infective endocarditis

Social determinants of health (SDOH) are well-recognized contributors of disparities in cardiovascular disease. Yet, the association of socioeconomic disadvantage with outcomes following operative management of infectious endocarditis (IE) remains ill-defined.

Nonelective adult (≥18 years) hospitalizations entailing cardiac valve operations for IE were tabulated from the 2016-2021 Nationwide Readmissions Database. Those facing adverse SDOH, including compromised economic, educational, healthcare, environmental, and social conditions, were categorized as Disadvantaged (others: Non-Disadvantaged). Multivariable regression models were developed to examine the association of socioeconomic disadvantage with key endpoints.

Of an estimated 36,527 hospitalizations, 31.9% were categorized as Disadvantaged with the proportion increasing from 27.0% in 2016 to 34.8% in 2021 (P < 0.001). On average, Disadvantaged was younger (50 [34-64] vs 53 years [37-65], P < 0.001), more frequently insured by Medicaid (33.8 vs 26.4%, P < 0.001), and more commonly underwent isolated tricuspid operations (21.9 vs 13.7%, P < 0.001). Following risk adjustment, Disadvantage remained linked with significantly greater likelihood of acute kidney injury (Adjusted Odds Ratio [AOR] 1.20, 95% Confidence Interval [CI] 1.12-1.29), stroke (AOR 1.25, 95%CI 1.11-1.41), and prolonged mechanical ventilation ≥24 hours (AOR 1.80, 95%CI 1.65-1.96). Further, Disadvantaged was associated with incremental increases in postoperative hospitalization duration (+4.97 days, 95%CI 4.39-5.54) and costs (+$32,900, 95%CI $29,300-36,500) as well as a greater risk of nonelective 90-day readmissions (AOR 1.12, 95%CI 1.03-1.23).

Adverse SDOH are independently linked with greater morbidity and resource utilization following surgical management of IE. Efforts are needed to ensure comprehensive SDOH screening upon admission and develop targeted in-hospital interventions to address persistent disparities.