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. 2025 Jan 31:24:332-340.
doi: 10.1016/j.xjon.2025.01.013. eCollection 2025 Apr.

Influence of socioeconomic status on postoperative outcomes in acute type A aortic dissection repair

Benjamin Hambright  1 , Lamario Williams  1 , Rongbing Xie  2 , Sasha A Still  2
Affiliations

Influence of socioeconomic status on postoperative outcomes in acute type A aortic dissection repair

Benjamin Hambright et al. JTCVS Open. .

Abstract

Objective: Type A aortic dissection repair is an emergency operation associated with both higher perioperative and postoperative risk. This study investigates the influence of socioeconomic status, as measured by the Distressed Communities Index (DCI), on patients who underwent acute aortic dissection repair and their postoperative outcomes.

Methods: We conducted a retrospective analysis of 240 adult patients who underwent repair for acute Stanford Type A aortic dissection from 2009 to 2021. Patients were categorized into an at-risk group (DCI score ≥75) and a not-at-risk group (DCI score <75) based on their zip code. We collected demographic, clinical, operative, and postoperative outcomes, analyzing data using descriptive statistics and multivariable logistic regression. Kaplan-Meier survival analysis assessed 5-year survival outcomes.

Results: At-risk patients were significantly younger (52 vs 59 years; P = .03) and more commonly African American (59.02% vs 26.5%; P < .0001). Although chronic health condition rates were similar, at-risk patients showed trends toward higher rates of postoperative respiratory failure (27.1% vs 18.0%; P = .0926) and longer hospital stays (27.05% vs 15.25% for length of stay of 8-13 days; P = .065). However, rates of postoperative complications, including 30-day mortality and 5-year survival, were not significantly different between groups, and at-risk status did not significantly predict mortality (hazard ratio, 1.35; 95% CI, 0.65-2.79; P = .43).

Conclusions: Patients undergoing urgent surgery for acute Type A aortic dissection have similar postoperative outcomes, although at-risk patients may experience longer hospital stays and higher respiratory failure rates. Further study is necessary to understand the effect of DCI score on intermediate and long-term outcomes to mitigate social disparities and diminish modifiable risk factors.

Keywords: DCI; aortic dissection; health disparities.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Kaplan-Meier survival curve for at-risk and not-at-risk cohorts.
Figure 2
Figure 2
Survival and hazard curves for patients undergoing aortic dissection from 2009 to 2024 (N = 240). This figure illustrates the survival and risk of death (hazard) over time for our study population.
Figure 1
Figure 1
Kaplan-Meier survival curves for patients undergoing aortic dissection by Distressed Communities Index (DCI) risk group (2009-2024) (N = 240). UAB, University of Alabama at Birmingham.
Figure 3
Figure 3
Forest plot of parametric hazard multivariable analysis of early-phase mortality in patients with Aortic Dissection (2009-2024) (N = 240). This forest plot shows predictors of mortality in patients undergoing Type A aortic dissection repair. DCI, Distressed Communities Index; BMI, body mass index.
See this image and copyright information in PMC

References

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