Mortality After Pediatric Cardiac Surgery in Patients From Disadvantaged Neighborhoods

Abstract

Background: Disadvantaged socioeconomic status correlates with adverse outcomes for patients with congenital heart disease. We examined individual and neighborhood characteristics associated with adverse short-term surgical outcomes and investigated potential drivers of disparities.

Methods: Single-center retrospective analysis collected clinical and demographic information on cardiovascular surgery patients over a 15-year period (2007-2022) from the District of Columbia metropolitan area. Neighborhood socioeconomic status, determined by the Child Opportunity Index, compared disadvantaged neighborhoods with advantaged neighborhoods. A stepwise multivariable model examined operative mortality and major surgical complication outcomes.

Results: Of the 2562 patients, one-half (49.6%) resided in disadvantaged neighborhoods. In bivariable analysis, nonmodifiable clinical factors were associated with higher operative mortality. Patients from disadvantaged neighborhoods had higher odds of surgical mortality compared with patients from advantaged neighborhoods (odds ratio, 1.52; 95% CI, 0.993-2.315; P = .054), though this relationship was not present in multivariable analysis (odds ratio, 0.91; 95% CI, 0.52-1.58; P = .73). Surgical factors such as The Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery (STAT) category, patient size, and genetic abnormalities predicted higher odds of operative mortality and major surgical complications.

Conclusions: Increased operative mortality experienced by patients from disadvantaged neighborhoods is influenced by nonmodifiable factors such as surgical complexity, patient size, and the presence of a genetic abnormality. To address these disparities, we must reconceptualize care for the preoperative patient.

Figure

Metropolitan-normed Child Opportunity Index (COI) categorization for the Washington, DC region by census tract.

Supplementary Figure