P249. Patients from Distressed Communities have Decreased Survival after Open Thoracic Aneurysm Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
New York, NY
United States - Contact Me
Gerardo is a 3rd-year medical student at Columbia University Vagelos College of Physicians and Surgeons. He was born and raised in Brooklyn, New York, and went to College at The City College of New York - CUNY where he graduated with a Bachelor of Science in Biology and a Minor in Spanish Language. During his pre-clinical years at Columbia, Gerardo focused on highlighting his Hispanic heritage through culturally educational events and community service events. He also worked to make learning medical spanish more accessible for non-native speakers at Columbia VP&S. Once he graduates medical school, he hopes to become a cardiac surgeon and work in predominantly underserved communities to help address and push towards health equity within cardiac surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: The association between socioeconomic status and mortality has been studied in a subset of cardiac surgery patients, however, this association is poorly defined in open thoracic aortic aneurysm repair. This study investigates the relationship between The Distressed Communities Index (a composite socioeconomic metric) and long-term mortality in aortic aneurysm repair.
Methods: This is a single-center retrospective study with 1416 patients who underwent open thoracic aortic aneurysm repair between 2005 and 2021. The Distressed Communities Index (DCI), which encompasses education level, poverty rate, unemployment, housing vacancy rate, median income, and change in the number of businesses, was used as a metric for socioeconomic status. Each patient's zip code was given a distressed score, with a higher score indicating a more at-risk community. Based on the patients' scores, they were subsequently placed into two separate groups. Group 1 was the not-distressed group classified by a DCI score of <40, while Group 2 was the distressed group classified by a DCI score of ≥40. The primary outcome of this study was 10-year mortality. Kaplan-Meier landmark analysis was used to analyze long-term mortality. Landmark analysis was done at the 1-year mark due to a significant number of deaths occurring within the first year. Multivariable Cox regression, including patient demographics and operative characteristics, was used to assess the association between DCI and mortality.
Results:
Of 1416 patients analyzed, 38% (n=533) were from a distressed community. These communities were also found to have more patients with comorbidities such as hypertension (76.9% vs. 69.3; p<0.01) and prior cerebrovascular accidents (7.1% vs. 4.0%; p=0.01). Additionally, patients in the more distressed communities were found to have higher rates of in-hospital mortality (4.9% vs. 1.9%; p<0.01), longer median length of hospital stay (9 days vs. 7 days; p<0.001) and higher rates of postoperative respiratory failure (15.9% vs. 9.9%; p<0.01). When comparing 30-day mortality, re-operation for bleeding, and AKI, both groups did not demonstrate a statistical difference. Patients from a more distressed community were then found to have an increased risk of long-term mortality (HR: 1.68; p=0.01), as well as being of a Non-Hispanic Other race and ethnicity (HR: 1.83 p=0.04), having a prior myocardial infarction (HR: 3.35; p<0.01), being a former smoker (HR 1.55; p=0.03), and having heart failure (HR: 1.58; p=0.03) as seen in our multivariable analysis. Patients from distressed communities had decreased survival probability at 1 year (p < 0.001) and in landmark analysis at 10 years (p=0.046) as seen in our Figure 1.
Conclusion
Being from a distressed community, defined by an elevated DCI score, is independently associated with worse long-term outcomes after aortic aneurysm repair. As more research is conducted towards acknowledging external factors that affect survival, socioeconomic status can be considered a part of surgical planning for improving patient outcomes and dismantling healthcare disparities.
Authors
Gerardo Ramos-Lemos (1), Kavya Rajesh (2), Dov Levine (3), Yanling Zhao (4), Yu Hohri (5), Thomas O'Donnell (5), Virendra Patel (6), Paul Kurlansky, MD (7), Hiroo Takayama (8)
Institutions
(1) N/A, United States, (2) N/A, N/A, (3) Columbia University, New York, NY, (4) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (5) Columbia University Irving Medical Center, New York, NY, (6) New York Presbytarian/Columbia, New York, NY, (7) Columbia University Medical Center, New York, NY, (8) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Methods: This is a single-center retrospective study with 1416 patients who underwent open thoracic aortic aneurysm repair between 2005 and 2021. The Distressed Communities Index (DCI), which encompasses education level, poverty rate, unemployment, housing vacancy rate, median income, and change in the number of businesses, was used as a metric for socioeconomic status. Each patient's zip code was given a distressed score, with a higher score indicating a more at-risk community. Based on the patients' scores, they were subsequently placed into two separate groups. Group 1 was the not-distressed group classified by a DCI score of <40, while Group 2 was the distressed group classified by a DCI score of ≥40. The primary outcome of this study was 10-year mortality. Kaplan-Meier landmark analysis was used to analyze long-term mortality. Landmark analysis was done at the 1-year mark due to a significant number of deaths occurring within the first year. Multivariable Cox regression, including patient demographics and operative characteristics, was used to assess the association between DCI and mortality.
Results:
Of 1416 patients analyzed, 38% (n=533) were from a distressed community. These communities were also found to have more patients with comorbidities such as hypertension (76.9% vs. 69.3; p<0.01) and prior cerebrovascular accidents (7.1% vs. 4.0%; p=0.01). Additionally, patients in the more distressed communities were found to have higher rates of in-hospital mortality (4.9% vs. 1.9%; p<0.01), longer median length of hospital stay (9 days vs. 7 days; p<0.001) and higher rates of postoperative respiratory failure (15.9% vs. 9.9%; p<0.01). When comparing 30-day mortality, re-operation for bleeding, and AKI, both groups did not demonstrate a statistical difference. Patients from a more distressed community were then found to have an increased risk of long-term mortality (HR: 1.68; p=0.01), as well as being of a Non-Hispanic Other race and ethnicity (HR: 1.83 p=0.04), having a prior myocardial infarction (HR: 3.35; p<0.01), being a former smoker (HR 1.55; p=0.03), and having heart failure (HR: 1.58; p=0.03) as seen in our multivariable analysis. Patients from distressed communities had decreased survival probability at 1 year (p < 0.001) and in landmark analysis at 10 years (p=0.046) as seen in our Figure 1.
Conclusion
Being from a distressed community, defined by an elevated DCI score, is independently associated with worse long-term outcomes after aortic aneurysm repair. As more research is conducted towards acknowledging external factors that affect survival, socioeconomic status can be considered a part of surgical planning for improving patient outcomes and dismantling healthcare disparities.
Authors
Gerardo Ramos-Lemos (1), Kavya Rajesh (2), Dov Levine (3), Yanling Zhao (4), Yu Hohri (5), Thomas O'Donnell (5), Virendra Patel (6), Paul Kurlansky, MD (7), Hiroo Takayama (8)
Institutions
(1) N/A, United States, (2) N/A, N/A, (3) Columbia University, New York, NY, (4) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (5) Columbia University Irving Medical Center, New York, NY, (6) New York Presbytarian/Columbia, New York, NY, (7) Columbia University Medical Center, New York, NY, (8) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Presentation Duration
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