Association of social vulnerability with a risk of readmission following cardiac surgery in a statewide collaborative.

Abstract

Background: The impact of neighborhood-level socioeconomic vulnerability remains to be elucidated within cardiac surgery. Using a multi-institutional database from a statewide collaborative, we analyzed the association of greater social vulnerability with 30-day readmission.

Methods: The 2018-2023 University of California Cardiac Surgery Consortium database was queried to identify all adult patients (≥18 years) undergoing coronary artery bypass grafting and/or valve procedures. The Haversine formula was applied to compute the distance between patient residence and operating hospital. Structural vulnerability was assessed using the well-validated social vulnerability index. This index was stratified into quartiles, with least vulnerable and most vulnerable groups compared in a pairwise approach. Kaplan-Meier time-to-event analyses and Cox proportional hazard models were used to assess readmission within 30 days.

Results: Among 5,704 patients, 680 (12.0%) were most vulnerable and 1,172 (31.2%) were least vulnerable. On average, when compared with least vulnerable patients, most vulnerable patients were similar in age, more often of female sex (33.0 vs 26.8%, P = .001), and Hispanic (39.0 vs 19.4%, P < .001). In addition, such patients traveled greater distances to the index hospital (87.2 ± 326.1 vs 113.7 ± 141.6 km, P < .001). After multivariable adjustment, most vulnerable patients were significantly associated with an increased odds of 30-day readmission (adjusted odds ratio: 1.5, 95% confidence interval: 1.0-2.1) and nonhome discharge (adjusted odds ratio: 1.4, 95% confidence interval: 1.0-2.0).

Conclusion: A high social vulnerability index appears to be associated with inferior outcomes after cardiac surgery. The incorporation of social vulnerability index into risk stratification may improve perioperative outcomes.