Abdominal Aortic Aneurysm Repair Readmissions and Disparities of Socioeconomic Status: A Multistate Analysis, 2007-2014

J Cardiothorac Vasc Anesth. 2019 Oct;33(10):2737-2745. doi: 10.1053/j.jvca.2019.03.020. Epub 2019 Mar 14.

Abstract

Objective(s): To determine differences in perioperative abdominal aortic aneurysm (AAA) repair outcomes based on patient sociodemographics.

Design: A retrospective analysis of patient hospitalization and discharge records.

Setting: All-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California.

Participants: A total of 92,028 patients from the State Inpatient Databases Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality from January 2007 to December 2014 (excluding California, ending December 2011) who underwent AAA repair.

Interventions: Data extraction and univariate and multivariate regression analysis.

Measurements and main results: Patients in the highest income quartile were less likely to be readmitted compared with those in the poorest income quartile at both 30 days (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.83-0.95) and 90 days (OR 0.85, 95% CI 0.81-0.91). Hospital readmissions were significantly greater for African American (OR 1.32, 95% CI 1.20-1.44) and Hispanic patients (OR 1.14, 95% CI 1.04-1.25) compared with white patients 30 days after AAA repair. These results were consistent 90 days after AAA repair. Patients insured with Medicare (OR 1.25, 95% CI 1.17-1.34) or Medicaid (OR 1.46, 95% CI 1.30-1.64) were more likely to be readmitted after both time points as compared with those with private insurance. The authors also found that patients with lower income, African American and Hispanic patients, and patients without private insurance were all significantly more likely to undergo emergency rather than elective repair.

Conclusions: Lower socioeconomic status is shown to be an independent risk factor for increased postoperative morbidity in AAA repair. The authors believe the present study demonstrates the importance of socioeconomic status as a factor in perioperative risk stratification.

Keywords: abdominal aortic aneurysm repair; administrative database research; healthcare disparities; socioeconomic status.

Publication types

  • Review

MeSH terms

  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / ethnology
  • Aortic Aneurysm, Abdominal / surgery*
  • Female
  • Health Status Disparities
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic Americans / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Male
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Medicare / statistics & numerical data
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Social Class
  • Treatment Outcome
  • United States / epidemiology