B. Badiee1, S. Mallick1, N. Le1, A. Chaturvedi1, P. Benharash1,2 2David Geffen School of Medicine, University of California at Los Angeles, Department Of Surgery, Los Angeles, CA, USA 1David Geffen School of Medicine, University of California at Los Angeles, Cardiovascular Outcomes Research Laboratories, Los Angeles, CA, USA
Introduction: While there is a recognized increase in the prevalence of infective endocarditis among socioeconomically disadvantaged patients, outcomes following cardiac surgery in such patients have yet to be fully elucidated. The present study thus used a national cohort to assess differences in outcomes following cardiac surgery.
Methods: The 2016-2021 Nationwide Readmissions Database was queried to identify all nonelective adult hospitalizations for open cardiac surgery with concomitant diagnosis for infective endocarditis. Socioeconomic disadvantage was defined using ICD-10 diagnosis codes related to social, educational, economic, healthcare, and environmental diagnoses, after which patients were categorized as Disadvantaged or Non-disadvantaged. The primary outcome was in-hospital mortality while secondary outcomes included complications, nonhome discharge, nonelective 30-day/90-day readmission rates, postoperative length of stay (LOS), and hospitalization costs. Multivariable logistic and linear models were used to evaluate the association between socioeconomic status and outcomes of interest.
Results: Among 36,527 patients, 31.9% were categorized as Disadvantaged. Compared to Non-disadvantaged, Disadvantaged patients were younger (50 [37-65] vs 58 years 50 [34-64], p<0.001), less commonly female (33.6% vs 38.6%, p<0.001), and more likely to be amongst the lowest income quartile (33.9% vs 30.4%, p<0.001). Furthermore, Disadvantaged patients more frequently presented with coagulopathy (26.5% vs 24.5%, p=0.01), liver disease (15.0% vs 11.1%, p<0.001), and pulmonary circulatory disorder (29.6% vs 22.9%, p<0.001). Following risk adjustment, Disadvantaged status was associated with increased odds of mortality (AOR 1.61, 95% CI 1.10-2.37, p=0.02) as well as acute kidney injury (AOR 1.36, 95% CI 1.07-1.74, p=0.01), prolonged mechanical ventilation (AOR 1.58, 95% CI 1.23-2.01, p<0.001), and reoperation (AOR 2.03, 95% CI 1.10-3.74, p=0.02). Additionally, Disadvantaged status was associated with longer postoperative LOS (β +3.68 days, 95% CI 1.72-5.63 days, p<0.001), increased costs (β +$26,000, 95% CI $15,000-$38,000, p<0.001), and increased odds of nonhome discharge (AOR 1.54, 95% CI 1.25-1.91, p<0.001).
Conclusion: Socioeconomic disadvantage was associated with adverse clinical outcomes and greater resource utilization among infective endocarditis patients undergoing open cardiac surgery. Early identification of this vulnerable population and development of specific care pathways is necessary to mitigate these disparities and improve outcomes.