Assessing the impact of socioeconomic distress on hospital readmissions after cardiac surgeryCentral MessagePerspective
Mohamad El Moheb, MD,
Abhinav Kareddy, BSc,
Steven Young, MD,
Matthew Weber, MD,
Sean Noona, MD,
Alexander Wisniewski, MD,
Anthony Norman, MD,
Zeyad Sahli, MD, MBA,
Raymond Strobel, MD, MSc,
Andrew Young, MD,
Jeffrey Rich, MD,
Abdulla Damluji, MD,
Mohammed Quader, MD,
Leora Yarboro, MD,
Nicholas Teman, MD,
Ourania Preventza, MD, MBA
Affiliations
Mohamad El Moheb, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Abhinav Kareddy, BSc
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Steven Young, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Matthew Weber, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Sean Noona, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Alexander Wisniewski, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Anthony Norman, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Zeyad Sahli, MD, MBA
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Raymond Strobel, MD, MSc
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Andrew Young, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Jeffrey Rich, MD
Virginia Cardiac Services Quality Initiative, Virginia Beach, Va
Abdulla Damluji, MD
Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Va
Mohammed Quader, MD
Department of Cardiac Surgery, Virginia Commonwealth University, Richmond, Va
Leora Yarboro, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Nicholas Teman, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
Ourania Preventza, MD, MBA
Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va; Address for reprints: Ourania Preventza, MD, MBA, Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA 22903.
Background: The impact of socioeconomic distress on readmission rates following cardiac surgery has not been studied. We hypothesized that patients living in distressed communities would have a higher 30-day readmission rate after cardiac surgery compared to those living in less distressed communities. Methods: Patients undergoing isolated coronary artery bypass grafting (CABG) between 2016 and 2023 within a regional collaborative were identified. The Distressed Communities Index (DCI) and Area Deprivation Index (ADI) were used to measure socioeconomic distress. Two logistic regression models were performed to evaluate 30-day readmission rates: one incorporating ADI and the other including DCI. Models were adjusted for the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) score, postoperative complications, length of stay (LOS), year of surgery, and discharge disposition. Results: A total of 16,369 patients were included, of whom 10% were readmitted within 30 days of discharge. Readmitted patients were more likely to be female (32% vs 23.3%) and to develop postoperative complications (47% vs 35%) and less likely to be discharged to home (70.6% vs 83.5%; P < .001 for all). On multivariable analysis, STS PROM score, postoperative complications, prolonged LOS, and discharge to a facility or leaving against medical advice were predictive of higher readmission rates. Socioeconomic distress was not an independent predictor of readmission in the model that used DCI (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.76-1.15) or in the model that used ADI (OR, 1.17; 95% CI, 0.83-1.64). Conclusions: In patients undergoing CABG, increasing socioeconomic distress does not predict higher 30-day readmission rate. Other factors, such as discharge location, have a greater impact on readmission rate.
