Rogers Michael P, DeSantis Anthony J, Janjua Haroon M, Kulshrestha Sujay, Kuo Paul C, Lozonschi Lucian
Surgery, University of South Florida Morsani College of Medicine, Tampa, USA.
Surgery, Loyola University Medical Center, Maywood, USA.
Cureus. 2022 Mar 30;14(3):e23643. doi: 10.7759/cureus.23643. eCollection 2022 Mar.
Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p<0.001), sepsis (3.6% vs. 1.9%, p<0.05), and cardiac complications (15.4% vs. 7.5%, p<0.001) when compared to highly distressed SAVR patients. When comparing distressed SAVR and TAVR and low distressed SAVR and TAVR groups, no significant difference was found in postoperative outcomes, except distressed TAVR experienced more cases of UTI. Conclusions Highly distressed TAVR patients had lower incidences of postoperative sepsis, pneumonia, and cardiac complications when compared to the highly distressed SAVR cohort. Patients undergoing TAVR in highly distressed communities had an increased incidence of postoperative urinary tract infection. DCI may be a useful adjunct to current risk scoring systems.
目的 社会经济地位较低的患者心脏手术后发生并发症的风险增加。我们旨在使用困境社区指数（DCI）来确定接受主动脉瓣置换术患者之间的差异，DCI是一种衡量社区福祉的比较指标。DCI将七个不同的社会经济指标纳入一个综合得分，以描述社区的经济福祉。方法 查询佛罗里达州和华盛顿州的医疗保健成本和利用项目州住院数据库（HCUP-SID），以确定2012年至2015年间接受外科和经导管主动脉瓣置换术（外科主动脉瓣置换术[SAVR]、经导管主动脉瓣置换术[TAVR]）的患者。对接受TAVR和SAVR的患者进行倾向匹配，并根据DCI得分的五分位数进行分层。困境社区定义为处于第4和第5五分位数的社区（分别为有风险和困境社区）；非困境社区定义为处于第1和第2五分位数的社区（分别为繁荣和舒适社区）。比较困境社区各组主动脉瓣置换术后的结果。使用倾向得分匹配来平衡各组之间的基线协变量。结果 共有27591例患者接受了主动脉瓣置换术。倾向匹配后，TAVR组和SAVR组各确定了5331例患者。与高度困境的SAVR患者相比，困境TAVR患者术后肺炎发生率较低（7.6%对3.8%，p<0.001）、败血症发生率较低（3.6%对1.9%，p<0.05）以及心脏并发症发生率较低（15.4%对7.5%，p<0.001）。比较困境SAVR和TAVR组与低度困境SAVR和TAVR组时，术后结果未发现显著差异，除了困境TAVR尿路感染病例较多。结论 与高度困境的SAVR队列相比，高度困境的TAVR患者术后败血症、肺炎和心脏并发症的发生率较低。在高度困境社区接受TAVR的患者术后尿路感染发生率增加。DCI可能是当前风险评分系统的有用辅助工具。
