Acute Kidney Injury as a Marker of Socioeconomic Vulnerability Following Carotid Endarterectomy

IntroductionSocioeconomic status (SES) has been recognized as a determinant of surgical outcomes, yet its impact on carotid endarterectomy (CEA) remains unclear. As standardized protocols have lowered rates of major neurologic complications, nonfatal morbidity may represent a more sensitive marker of perioperative vulnerability. This study evaluated whether community-level socioeconomic distress, measured using the Distressed Communities Index (DCI), was associated with postoperative complications following CEA.MethodsA retrospective cohort analysis was conducted using the Maryland State Inpatient Database (2018-2020). The DCI, a zip code-linked composite measure of community-level socioeconomic distress, was categorized into quintiles (1 = prosperous, 5 = distressed). Postoperative complications were compared. Multivariable logistic regression assessed the association between DCI and AKI.ResultsAmong 3027 patients undergoing CEA, those in the distressed quintile were younger (mean age 69.5 vs 72.5 years, P < 0.001), more likely female (49.4% vs 40.2%, P = 0.017), more likely African American (24.5% vs 8.0%, P < 0.001), and had a higher prevalence of comorbidities. AKI occurred in 6.0% of patients in the distressed quintile compared to 1.9% in the prosperous (P = 0.001). No significant differences were observed for other complications. After adjustment, residence in a distressed community remained independently associated with AKI (OR 2.39 CI 1.14-5.03, P = 0.021).ConclusionCommunity-level socioeconomic distress was independently associated with postoperative AKI after CEA. As benchmarks reach a performance ceiling, renal complications emerge as a sensitive clinical differentiator of perioperative vulnerability. Integrating social determinants into risk stratification may enhance identification of patients at risk for preventable morbidity.