Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years.

Autor:	Pagano D; Cardiothoracic Surgical Unit, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH. domenico.pagano@uhb.nhs.uk, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, Keogh BE
Jazyk:	angličtina
Zdroj:	BMJ (Clinical research ed.) [BMJ] 2009 Apr 02; Vol. 338, pp. b902. Date of Electronic Publication: 2009 Apr 02.
DOI:	10.1136/bmj.b902
Abstrakt:	Objective: To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. Design: Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. Setting: Birmingham and north west England. Participants: 44 902 adults undergoing cardiac surgery, 1997-2007. Main Outcome Measures: Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up. Results: In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001). Conclusions: Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.
Databáze:	MEDLINE
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