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Strobel RJ, Charles EJ, Mehaffey JH, Hawkins RB, Quader MA, Rich JB, Speir AM, Ailawadi G. Effect of Socioeconomic Distress on Risk-Adjusted Mortality After Valve Surgery for Infective Endocarditis. Semin Thorac Cardiovasc Surg 2022; 35:497-507. [PMID: 35588950 DOI: 10.1053/j.semtcvs.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/11/2022]
Abstract
Infective endocarditis affects patients of all socioeconomic status. We hypothesized that the Distressed Communities Index (DCI), a comprehensive assessment of socioeconomic status, would be associated with risk-adjusted mortality for patients with endocarditis. All patients with endocarditis (2001-2017) in a regional Society of Thoracic Surgeons database were analyzed. DCI scores range from 0 (no socioeconomic distress) to 100 (severe distress) and account for unemployment, poverty rate, median income, housing vacancies, education level, and business growth by zip code. The most distressed patients (top quartile, DCI > 75) were compared to all other patients. Hierarchical logistic regression modeled the association between DCI and mortality. A total of 2,075 patients were included (median age 55 years, 65.2% urgent/emergent cases, 42.7% self-pay). Major morbidity was 32.8% and operative mortality was 9.5%. Tricuspid/pulmonic valve endocarditis was present in 12.5% of cases, with significantly worse mean DCI compared to patients with left-sided endocarditis (median 55.3, IQR 20.3-77.6 vs 46.8, IQR 17.3-74.2, P = 0.016). High socioeconomic distress (DCI > 75) was associated with higher rates of major morbidity, operative mortality, increased length of stay, and higher total cost. After risk-adjustment, DCI was independently predictive of higher operative mortality for patients with endocarditis (OR 1.24 per DCI quartile increase, 95% CI 1.06-1.45, P < 0.001). Increasing DCI, an indicator of poor socioeconomic status, independently predicts increased risk-adjusted mortality and resource utilization for patients with endocarditis. Accounting for socioeconomic status allows for more accurate risk prediction and resource allocation for patients with endocarditis.
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Affiliation(s)
- Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - Eric J Charles
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - Robert B Hawkins
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mohammed A Quader
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan M Speir
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Gorav Ailawadi
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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El-Dalati S, Yoon P, Deeb GM. Is It Time to Rethink Public Reporting of Surgical Endocarditis Outcomes in Patients Who Inject Drugs? J Am Heart Assoc 2021; 10:e020090. [PMID: 33955234 PMCID: PMC8200709 DOI: 10.1161/jaha.120.020090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sami El-Dalati
- Division of Infectious Diseases Department of Internal Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Pyongsoo Yoon
- Division of Cardiac Surgery and Heart Transplant Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Pittsburgh PA
| | - George Michael Deeb
- Department of Cardiac Surgery University of Michigan Health Systems Ann Arbor MI
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