Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 7:11:1286100.
doi: 10.3389/fcvm.2024.1286100. eCollection 2024.

Socioeconomic status as a predictor of post-operative mortality and outcomes in carotid artery stenting vs. carotid endarterectomy

Jigesh Baxi  1 , Joshua C Chao  1 , Krish Dewan  1 , NaYoung K Yang  2 , Russell J Pepe  1 , Xiaoyan Deng  3 , Fady K Soliman  1 , Lindsay Volk  1 , Saum Rahimi  2   4 , Mark J Russo  1   2 , Leonard Y Lee  1   2
Affiliations

Socioeconomic status as a predictor of post-operative mortality and outcomes in carotid artery stenting vs. carotid endarterectomy

Jigesh Baxi et al. Front Cardiovasc Med. .

Abstract

Background: The association between low socioeconomic status (SES) and worse surgical outcomes has become an emerging area of interest. Literature has demonstrated that carotid artery stenting (CAS) poses greater risk of postoperative complications, particularly stroke, than carotid endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing CAS vs. CEA.

Methods: The National Inpatient Sample (NIS) was queried for patients undergoing CAS and CEA from 2010 to 2015. Patients were stratified by highest and lowest median income quartiles by zip code and compared through demographics, hospital characteristics, and comorbidities defined by the Charlson Comorbidity Index (CCI). Primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), post-operative stroke, sepsis, and bleeding requiring reoperation.Multivariable logistic regression was used to determine the effect of SES on outcomes.

Results: Five thousand four hundred twenty-five patients underwent CAS (Low SES: 3,516 (64.8%); High SES: 1,909 (35.2%) and 38,399 patients underwent CEA (Low SES: 22,852 (59.5%); High SES: 15,547 (40.5%). Low SES was a significant independent predictor of mortality [OR = 2.07 (1.25-3.53); p = 0.005] for CEA patients, but not for CAS patients [OR = 1.21 (CI 0.51-2.30); p = 0.68]. Stroke was strongly associated with low SES, CEA patients (Low SES = 1.5% vs. High SES = 1.2%; p = 0.03), while bleeding was with high SES, CAS patients (Low SES = 5.3% vs. High SES = 7.1%; p = 0.01). CCI was a strong predictor of mortality for both procedures [CAS: OR1.45 (1.17-1.80); p < 0.001. CEA: OR1.60 (1.45-1.77); p < 0.001]. Advanced age was a predictor of mortality post-CEA [OR = 1.03 (1.01-1.06); p = 0.01]. While not statistically significant, advanced age and increased mortality trended towards a positive association in CAS [OR = 1.05 (1.00-1.10); p = 0.05].

Conclusions: Low SES is a significant independent predictor of post-operative mortality in patients who underwent CEA, but not CAS. CEA is also associated with higher incidence of stroke in low SES patients. Findings demonstrate the impact of SES on outcomes for patients undergoing carotid revascularization procedures. Prospective studies are warranted to further evaluate this disparity.

Keywords: carotid artery stenosis; carotid artery stenting (CAS); carotid endarterectomy (CEA); outcomes; socioeconomic status (SES).

PubMed Disclaimer

Conflict of interest statement

MR discloses financial relationships with Edwards Lifesciences and Abbott Laboratories. LL discloses a financial relationship with Abbott Laboratories. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Independent predictors of mortality.
Figure 2
Figure 2
Secondary outcomes acute kidney injury (AKI), stroke, sepsis, bleeding requiring reoperation in patients stratified by low (red) vs. high (blue) socioeconomic status who underwent (A) carotid artery stenting (CAS) or (B) carotid endarterectomy (CEA).
See this image and copyright information in PMC

References

    1. Arya S, Binney Z, Khakharia A, Brewster LP, Goodney P, Patzer R, et al. Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease. J Am Heart Assoc. (n.d.) 7(2):e007425. 10.1161/JAHA.117.007425 - DOI - PMC - PubMed
    1. Bennett KM, Scarborough JE, Pappas TN, Kepler TB. Patient socioeconomic status is an independent predictor of operative mortality. Ann Surg. (2010) 252(3):552. 10.1097/SLA.0b013e3181f2ac64 - DOI - PubMed
    1. Birkmeyer NJO, Gu N, Baser O, Morris AM, Birkmeyer JD. Socioeconomic status and surgical mortality in the elderly. Med Care. (2008) 46(9):893–9. 10.1097/MLR.0b013e31817925b0 - DOI - PubMed
    1. Jerath A, Austin PC, Ko DT, Wijeysundera HC, Fremes S, McCormack D, et al. Socioeconomic status and days alive and out of hospital after major elective noncardiac surgery: a population-based cohort study. Anesthesiology. (2020) 132(4):713–22. 10.1097/ALN.0000000000003123 - DOI - PubMed
    1. Li G, Patil CG, Lad SP, Ho C, Tian W, Boakye M. Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine. (2008) 33(11):1250. 10.1097/BRS.0b013e3181714a44 - DOI - PubMed

LinkOut - more resources