Patients with lower socioeconomic status face bigger incisions, fewer repairs, more complications, and higher mortality
WEDNESDAY, Feb. 9, 2022 (HealthDay News) — Neighborhood-level socioeconomic status (SES) significantly predicts mortality and repair rate in patients undergoing isolated mitral valve surgery for degenerative disease, according to a study presented at the annual meeting of The Society of Thoracic Surgeons (STS), held virtually from Jan. 29 to 30.
Amit Iyengar, M.D., from the University of Pennsylvania in Philadelphia, and colleagues used data from the STS Adult Cardiac Surgery Database between 2012 and 2018 to identify 46,183 adults undergoing first-time, isolated mitral valve surgery for degenerative mitral disease. Patients’ SES was estimated utilizing the 2018 Area Deprivation Index (ADI) at a census block group level.
The researchers found that high-SES patients had more elective presentations (88 versus 82 percent) and less urgent surgery (13 versus 21 percent). Patients with higher SES tended to travel farther to receive surgery (33 versus 17 miles) and receive operations from higher-volume surgeons (62 versus 31 cases/year). Furthermore, high SES was associated with a higher repair rate (82.8 versus 65.3 percent), more minimally invasive approach (39 versus 24 percent), lower composite complication rate (40 versus 48 percent), and lower 30-day mortality (1.3 versus 2.9 percent). ADI significantly predicted 30-day mortality and repair rate in an adjusted analysis.
“Neighborhood SES is associated with differing valve pathologies and presentations,” Iyengar said in a statement. “Clinically, the extremes of SES represent two differing patient populations — elective degenerative pathology (high SES) and more urgent, nondegenerative pathology (low SES).”
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