Socioeconomic status did not impact pandemic-era cardiac surgery outcomes
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The COVID-19 pandemic increased risk for negative cardiac surgery outcomes, but socioeconomic status did not significantly affect surgical outcomes during the pandemic, researchers reported.
However, researchers said the lack of individuals from distressed communities undergoing surgical procedures during the pandemic may indicate further issues in health care availability for distressed communities.
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“Our analysis adds to the growing body of research demonstrating that the COVID-19 pandemic stressed hospital systems and caused resource and capacity limitations that negatively affected patient outcomes,” Emily F. Kaplan, MD candidate at the University of Virginia School of Medicine, and colleagues wrote in The Annals of Thoracic Surgery.
In a regional retrospective cohort study of 37,769 individuals (mean age, 66 years; 28.2% women; 81% white; 19.7% had surgery during the COVID-19 pandemic) undergoing a Society of Thoracic Surgeons (STS) index operation in one of the 17 medical centers included in the Virginia Cardiac Services Quality Initiative between July 2011 and May 2022, Kaplan and colleagues analyzed the impact of socioeconomic status on the relationship between the COVID-19 pandemic and cardiac surgery outcomes.
To determine the socioeconomic status of participants, researchers utilized Distressed Communities Index (DCI) scores, which incorporates a community’s percentage of residents with a high school degree, housing vacancy rate, unemployment rate, poverty rate, median income ratio, change in employment and change in business establishments.
Variables for logistic regressions included operative mortality, major morbidity, failure to rescue and cost adjusted for DCI score, STS predicted risk of mortality (PROM), intraoperative characteristics and hospital random effect.
Participants were grouped into whether their procedures were before or during the COVID-19 pandemic.
Kaplan and colleagues found that, on average, individuals undergoing surgery during the pandemic were from less distressed communities than individuals undergoing surgery before the pandemic (DCI scores, 37.4 vs. 41.9; P < .001). Those who had their procedures during the pandemic also had a lower STS PROM than individuals undergoing surgery before the pandemic (2.16% vs. 2.53%; P < .001).
“We found that pandemic-era cardiac surgery patients had a higher average socioeconomic status (ie, lower DCI score) as compared with patients treated before the pandemic,” Kaplan and colleagues wrote. “This finding suggests that the pandemic may have precluded poorer and marginalized patients from making it to hospitals in the first place, possibly resulting in their death at home secondary to acute coronary syndrome, critical aortic stenosis or other treatable cardiovascular conditions.”
After researchers adjusted for risk factors, they found that the pandemic increased mortality risk (OR = 1.398; 95% CI, 1.179-1.657; P < .001), cost (difference, $4,823; P < .001) and failure to rescue (OR = 1.37; 95% CI, 1.1-1.7; P = .005).
There was no significant difference in the negative impact of the pandemic between individuals with varying DCI scores, according to researchers.
“Given the increase in postoperative failure to rescue and mortality and decrease in patients from distressed communities seen during the COVID-19 pandemic, there clearly exists a need for evidence-based cardiac surgery protocols for resource-constrained settings, and particularly, infectious disease outbreaks,” Kaplan and colleagues wrote.
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