Neighborhood socioeconomic status and length of stay after congenital heart disease surgery

Vashist, Sudhir; Dudeck, Brandon; Sherfy, Beth; Rosenthal, Geoffrey L.; Chaves, Alicia H.

doi:10.3389/fped.2023.1167064

Cited by 2 publications

(1 citation statement)

References 31 publications

(45 reference statements)

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“…Bucholz et al demonstrated that a marker of socioeconomic status was not associated with LOS following the Norwood procedure (a STAT 5 procedure) [ 20 ]; however, for a similar patient population (patients post Norwood procedure), Spigel et al demonstrated a significant increase in LOS [ 21 ]. While there is variability in the relationship between SDOH and various clinical outcomes, a growing body of literature is demonstrating a relationship between SDOH and increased LOS, including in patients with surgical CHD across multiple STAT categories [ 22 ]. The specific underlying factors driving this relationship are not yet clear.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Influences on Outcomes Following Congenital Heart Disease Surgery

Schneider,

de Loizaga,

Beck

et al. 2024

Pediatr Cardiol

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Associations between social determinants of health (SDOH) and adverse outcomes for children with congenital heart disease (CHD) are starting to be recognized; however, such links remain understudied. We examined the relationship between community-level material deprivation on mortality, readmission, and length of stay (LOS) for children undergoing surgery for CHD. We performed a retrospective cohort study of patients who underwent cardiac surgery at our institution from 2015 to 2018. A community-level deprivation index (DI), a marker of community material deprivation, was generated to contextualize the lived experience of children with CHD. Generalized mixed-effects models were used to assess links between the DI and outcomes of mortality, readmission, and LOS following cardiac surgery. The DI and components were scaled to provide mean differences for a one standard deviation (SD) increase in deprivation. We identified 1,187 unique patients with surgical admissions. The median LOS was 11 days, with an overall mortality rate of 4.6% and readmission rate of 7.6%. The DI ranged from 0.08 to 0.85 with a mean of 0.37 (SD 0.12). The DI was associated with increased LOS for patients with more complex heart disease (STAT 3, 4, and 5), which persisted after adjusting for factors that could prolong LOS (all p < 0.05). The DI approached but did not meet a significant association with mortality (p = 0.0528); it was not associated with readmission (p = 0.36). Community-level deprivation is associated with increased LOS for patients undergoing cardiac surgery. Future work to identify the specific health-related social needs contributing to LOS and identify targets for intervention is needed.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Influences on Outcomes Following Congenital Heart Disease Surgery

Schneider,

de Loizaga,

Beck

et al. 2024

Pediatr Cardiol

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Socio-economic disparities in unplanned hospital admission and in- hospital outcomes among children with congenital heart disease

Ghimire,

Khanal,

Torabyan

et al. 2024

Preprint

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Unplanned/non-elective admissions have been associated with worse clinical outcomes and increased use of hospital resources. We hypothesize that children with congenital heart disease (CHD) from lower socio-economic status backgrounds have higher rates of unplanned hospital admissions and increased hospital resource utilization. We used Kids’ Inpatient Database (2016 and 2019). We included children < 21 years of age with CHD, and excluded newborn hospitalization. We further categorized CHD into simple lesions, complex bi-ventricular lesions, and single ventricle lesions. Admission types were further divided into surgical and non-surgical admissions. We used a logistic regression model to calculate the risk of unplanned hospital admission, mortality, and hospital resource utilization in children with different socio-economic status backgrounds. Out of 4,722,684 admitted children, excluding those with newborn hospitalization, 199,757 had CHD and met the study criteria. 121,626 had mild CHD, 61,639 complex bi-ventricular lesions, and 16,462 single ventricle lesions. Surgical admission comprised 20%(n = 39,694). In the CHD cohort, 27% had elective admissions, while 73% had non-elective admissions. Mortality was higher in unplanned admissions vs elective admissions, 3.0% vs 0.93%, P < 0.001. Unplanned admissions were more common in lowest income neighborhoods vs highest income neighborhoods, aOR = 1.4(1.3–1.5), P < 0.001 and were consistent at different age groups. There were higher rates of unplanned admissions in lowest income neighborhoods for each category of CHD and for both medical and surgical admission groups. Lengths of hospitalization were longer in the poorest neighborhood compared to their wealthiest counterparts, median of 7 days (IQR 3–21) vs 6 (3–17), P < 0.001. In conclusion, children with CHD who live in lowest income neighborhoods have increased odds of unplanned hospitalization for both surgical and non-surgical admissions and have higher mortality and resource utilization.

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Neighborhood socioeconomic status and length of stay after congenital heart disease surgery

Cited by 2 publications

References 31 publications

Socioeconomic Influences on Outcomes Following Congenital Heart Disease Surgery

Socioeconomic Influences on Outcomes Following Congenital Heart Disease Surgery

Socio-economic disparities in unplanned hospital admission and in- hospital outcomes among children with congenital heart disease

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