P132. Exploring the Impact of Socioeconomic Vulnerability on Elective Aortic Valvular Surgery Presentation and Outcomes

Sheraton Times Square 

Objective:
Previously, we observed various presentations between two Social Vulnerability Index (SVI) cohorts, demonstrating that high SVI patients tended to present more urgently or emergently for aortic arch/valvular surgery. To further understand the healthcare accessibility and dynamics, this study aims to explore the role of SVI in surgical outcomes among the referred patients who required elective aortic arch/valvular surgery.

Methods:
We used a single-institution database of patients who underwent aortic valve repair/replacement with total arch or hemiarch replacement for aortic root and/or arch aneurysms between 2009 and 2023. A total of 280 patients were reviewed and 227 patients were placed into two cohorts – high social vulnerability (SVI ≥75%, N=32) and normal social vulnerability (SVI < 75%, N=195) after excluding those receiving surgery for other indications. We compared patient characteristics and presentations (i.e. prevalence of severe valvular disease), operative variables and subsequent outcomes based on the two cohorts.

Results:
There was significant difference in body mass index (BMI), with the high SVI cohort having a higher BMI (median 28.5) than the normal SVI cohort (p = 0.05). Patients in the high SVI cohort tended to be younger, with a median age of 59.2, in contrast to the normal SVI cohort with a median age of 64.9 (p = 0.06). Additionally, a higher proportion of individuals in the high SVI group had a history of smoking (37.5% vs. 22.6%, p = 0.078). However, no significant differences were observed between the two cohorts in terms of gender or medical history, including hypertension, hyperlipidemia, diabetes, chronic kidney disease, pulmonary disease, coronary artery disease, or severe aortic stenosis or aortic insufficiency. The analysis of operative variables revealed no significant differences in the operative types (aortic root or arch replacement), cardiopulmonary bypass time, and aortic cross-clamping time. Postoperatively, both cohorts exhibited comparable outcomes with no significant differences noted in adverse events such as length of stay, ICU days, acute kidney injury requiring hemodialysis, stroke, prolonged ventilation, postoperative infection, need for mechanical circulatory support, or mortality.

Conclusions:
Among elective patients, high SVI did not appear to affect the pre-operative presentation except that the high SVI cohort had higher BMI, tended to be younger and have smoking history. Referred patients regardless of SVI had similar pre-operative presentations and post-operative outcomes compared to high SVI patients. Our results suggest that disparities in care do not occur at the time of seeing a specialist, rather they either occur at two levels: either in obtaining initial access to primary care, or in failure to appropriately see a referred specialist.

Authors
Adam Carroll (1), Bo Chang Wu (1), Nicolas Chanes (1), Michael Kirsch (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO

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