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

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.