The Journal of Thoracic and Cardiovascular Surgery
Adult: Mitral ValveContemporary socioeconomic-based disparities in cardiac surgery: Are we closing the disparities gap?
Graphical abstract
Section snippets
Data Source
In our study we used data from the Nationwide Readmissions Database (NRD)—a publicly available, deidentified data set that contains nationally representative information on hospital readmissions for all ages, which when weighted represents 35 million discharges annually.18 The extent of the clinical data available within NRD is limited to International Classification of Diseases (ICD) diagnosis and procedure codes. Furthermore, data are deidentified and thus specific geographic or hospital data
Patient Characteristics
A weighted total of 358,762 patients met inclusion criteria. A total of 187,296 patients underwent CABG, 109,110 SAVR, 31,009 MVR, 5579 MV repair, and 25,768 ascending aorta surgery. Baseline characteristics were largely similar among cardiac procedures (Table E3).
In comparing characteristics according to patient sex, female patients were the minority for most procedures (22.3% for CABG, 32.2% for SAVR, 37.5% MV repair, and 29.7% for ascending aorta surgery). Female patients had higher mean HES
Discussion
In this study we characterized the current state of socioeconomic disparities in cardiac surgery by conducting, to our knowledge, the largest and most contemporary nationally representative study to date with several important findings (Figure 3). First, female patients are undergoing fewer CABG, SAVR, MV repair, and ascending aorta surgeries than males patients, and when they do receive surgery they have more comorbidities and more often have urgent procedures. Second, female sex was an
Conclusion
Despite advances in cardiovascular surgical care, and health policy initiatives implemented in the past decade to close the disparities gap in cardiac surgery, women and patients of lower MHIQs continue to have worse outcomes after cardiac surgery on a national level. Future research should be focused on root-cause analysis for each procedure type, with a greater focus on sex-specific management guidelines and reevaluation of our approach to health policy to combat structural barriers to care.
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