Unplanned readmissions, community socioeconomic factors, and their effects on long-term survival after complex thoracic aortic surgery

Objective

We evaluated community socioeconomic (CSE) factors in patients who had unplanned readmission after undergoing proximal aortic surgery (ascending aorta, aortic root, or arch).

Methods

Unplanned readmissions for any reason within 60 days of the index procedure were reviewed by race, acuity at presentation, and gender. We also evaluated 3 CSE factors: poverty, household income, and education. Kaplan-Meier survival curves were used to assess long-term survival differences by group (race, acuity, gender).

Results

Among 2406 patients who underwent proximal aortic surgery during the 20-year study period and were discharged alive, our team identified 146 (6.1%) unplanned readmissions. Compared with White patients, Black patients lived in areas characterized by more widespread poverty (20.8% vs 11.1%, p=.0003), lower income (42,776 vs 65,193 USD, p=.0007), and fewer residents with a high school diploma (73.7% vs 90.1%, p <.0001). Compared with patients whose index operation was elective, patients who had urgent or emergency index procedures lived in areas with lower income (54,425 vs 64,846 USD, p=.01) and fewer residents with a high school diploma (81.1% vs 89.2%, p=.005). CSE factors did not differ by gender. Four- and 6-year survival estimates were 63.1% and 63.1% for Black patients versus 89.1% and 83.0% for White patients (p=.0009). No significant differences by acuity or gender were found.

Conclusions

Among readmitted patients, Black patients and patients who had emergency surgery had less favorable CSE factors and poorer long-term survival. Earlier and more frequent follow-up in these patients should be considered. Developing off-campus clinics and specific post-discharge measures targeting these patients is important.