Patients from distressed communities have decreased survival after open thoracic aneurysm repair

Abstract

Objective

This study investigates the relationship between the Distressed Communities Index and long-term mortality in thoracic aortic aneurysm repair.

Methods

This single-center retrospective study includes patients who underwent open thoracic aortic aneurysm repair between 2005 and 2021. The Distressed Communities Index served as a metric for socioeconomic status by providing distress scores for each patient's zip code. Patients were placed into the nondistressed group with a score of 50 or less or the distressed group with a score greater than 50. The primary outcome of this study was 10-year mortality. Multivariable Cox regression evaluated factors associated with long-term mortality while accounting for patient demographics and operative characteristics.

Results

Of 1317 patients, 31% (n = 409) comprised the distressed group, which had higher rates of hypertension (P = .002), chronic obstructive pulmonary disease (P = .03), diabetes (P = .008), cerebrovascular disease (P = .04), and chronic kidney disease (P = .04). This group also experienced higher rates of surgical site infection (P = .02), postoperative respiratory failure (P = .006), and longer hospital stays (P < .001), as well as decreased survival probability at 1 year (P < .001) and beyond (P = .03). Multivariable logistic regression revealed that being in the distressed group was independently associated with increased long-term mortality risk (hazard ratio, 1.66; P = .005).

Conclusions

Being from a distressed community is associated with worse long-term mortality after thoracic aortic aneurysm repair. Socioeconomic status should be considered in surgical planning to improve patient outcomes and dismantle healthcare disparities.