Neighborhood Socioeconomic Status and Readmission in Acute Type A Aortic Dissection Repair.

Autor: Liu T; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Devlin PJ; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Whippo B; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Vassallo P; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Hoel A; Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Pham DT; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Johnston DR; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Chris Malaisrie S; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Mehta CK; Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: christopher.mehta@nm.org.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Apr; Vol. 296, pp. 772-780. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1016/j.jss.2023.12.049
Abstrakt: Introduction: We examined the association of socioeconomic status as defined by median household income quartile (MHIQ) with mortality and readmission patterns following open repair of acute type A aortic dissection (ATAAD) in a nationally representative registry.
Methods: Adults who underwent open repair of ATAAD were selected using the US Nationwide Readmissions Database and stratified by MHIQ. Patients were selected based on diagnostic and procedural codes. The primary endpoint was 30-d readmission.
Results: Between 2016 and 2019, 10,288 individuals (65% male) underwent open repair for ATAAD. Individuals in the lowest income quartile were younger (median: 60 versus 64, P < 0.05) but had greater Elixhauser comorbidity burden (5.9 versus 5.7, P < 0.05). Across all groups, in-hospital mortality was approximately 15% (P = 0.35). On multivariable analysis adjusting for baseline comorbidity burden, low socioeconomic status was associated with increased readmission at 90 d, but not at 30 d. Concomitant renal disease (odds ratio [OR], 1.68; P < 0.001), pulmonary disease (OR, 1.26; P < 0.001), liver failure (OR 1.2, P = 0.04), and heart failure (OR, 1.17; P < 0.001) were all associated with readmission at 90 d. The primary indication for readmission was most commonly cardiac (33%), infectious (16.5%), and respiratory (9%).
Conclusions: In patients who undergo surgery for ATAAD, lower MHIQ was associated with higher odds of readmission following open repair. While early readmission for individuals living in the lowest income communities is likely attributable to greater baseline comorbidity burden, we observed that 90-d readmission rates are associated with lower MHIQ regardless of comorbidity burden. Further investigation is required to determine which patient-level and system-level interventions are needed to reduce readmissions in the immediate postoperative period for resource poor areas.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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