Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisalCentral MessagePerspective

Autor: Sara Sakowitz, MS, MPH, Syed Shahyan Bakhtiyar, MD, MBE, Saad Mallick, MD, Arjun Verma, BS, Yas Sanaiha, MD, Richard Shemin, MD, Peyman Benharash, MD
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: JTCVS Open, Vol 20, Iss , Pp 89-100 (2024)
Druh dokumentu: article
ISSN: 2666-2736
DOI: 10.1016/j.xjon.2024.05.015
Popis: Objective: Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade. Methods: All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year. Results: Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (P
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