Outcomes following major cardiac procedures in socially vulnerable patients are not improved at high-volume centers

The association between social determinants of health and adverse perioperative outcomes is well established across surgical specialties. While treatment at high-volume hospitals has been historically linked to improved survival and outcomes following cardiac surgery, it remains unclear whether these volume-associated benefits extend to socially vulnerable populations.

The 2016-2022 National Inpatient Sample was queried to identify all adult (≥18 years) hospitalizations that included elective coronary artery bypass grafting and isolated or concomitant valve procedures. We ascertained the presence of social vulnerability using validated International Classification of Diseases, Tenth Revision diagnosis codes. Patients with at least 1 documented social determinant of health risk factor were grouped as vulnerable (others: nonvulnerable). Hospitals in the highest quartile by cumulative center-level cardiac operation volume were categorized as high-volume hospitals. Multivariable regressions were employed to evaluate the association between social determinants of health and outcomes of interest.

Of an estimated 957,570 cardiac patients meeting inclusion criteria, 6.2% were defined as vulnerable. Following comprehensive risk adjustment, the vulnerable group demonstrated increased mortality (adjusted odds ratio, 2.20; 95% confidence interval, 1.97-2.45), major complications (adjusted odds ratio, 1.80; 95% confidence interval, 1.72-1.89), and failure to rescue (adjusted odds ratio, 1.67; 95% confidence interval, 1.49-1.87). Vulnerable continued to be associated with increased failure to rescue (adjusted odds ratio, 1.83; 95% confidence interval, 1.58-2.10) at high-volume hospitals. Importantly, the interaction between vulnerable group and treatment at high-volume hospitals was insignificant.

Social vulnerability remained profoundly associated with increased mortality, major complications, and failure to rescue following major cardiac operations. Treatment at high-quality surgical facilities alone does not sufficiently address these disparities, emphasizing the need for broader systemic efforts.