Association Between Social Vulnerability and Postoperative Complications and Readmission Among Cardiovascular Surgery Patients.

Abstract

Despite the well-established importance of health-related social needs in shaping patient outcomes, gaps remain in the literature examining these relationships at the individual level among patients undergoing cardiac surgery. This retrospective study used data from the 2016-2018 Nationwide Readmission Database to evaluate postoperative complications and readmissions in patients undergoing cardiac surgery (coronary artery bypass grafting, aortic surgery, valve surgery, or a combination) using individual-level social vulnerability clinically acknowledged using ICD-10 Z-codes. Six domains of ICD-10 Z-codes (employment, family, housing, psychosocial needs, socioeconomic status, dependence) were considered social vulnerabilities. Data were analyzed using stratification by social vulnerability status and multivariable logistic regression. Among the 846,837 included patients, dependence-related needs were the most documented domain. Patients with social vulnerability at any point were younger, had a longer length of stay, and had a higher prevalence of comorbid conditions, readmissions, and complications. For patients with social vulnerability, the odds ratio of complications was 1.12 (1.03-1.22), and the odds ratio of 90-day readmissions was 1.15 (1.03-1.27). Clinically acknowledged social vulnerability at any point was associated with higher odds of complications or readmissions after cardiac surgery. Z-codes may be useful for identifying nonmedical factors that can affect patient outcomes, but further standardization and assessment are needed.