University of Virginia School of Medicine, Charlottesville, Virginia.
Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Ann Thorac Surg. 2023 Jun;115(6):1511-1518. doi: 10.1016/j.athoracsur.2022.12.042. Epub 2023 Jan 22.
Increasing socioeconomic distress has been associated with worse cardiac surgery outcomes. The extent to which the pandemic affected cardiac surgical access and outcomes remains unknown. We sought to examine the relationship between the COVID-19 pandemic and outcomes after cardiac surgery by socioeconomic status.
All patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collaborative, the Virginia Cardiac Services Quality Initiative (2011-2022), were analyzed. Patients were stratified by timing of surgery before vs during the COVID-19 pandemic (March 13, 2020). Hierarchic logistic regression assessed the relationship between the pandemic and operative mortality, major morbidity, and cost, adjusting for the Distressed Communities Index (DCI), STS predicted risk of mortality, intraoperative characteristics, and hospital random effect.
A total of 37,769 patients across 17 centers were included. Of these, 7269 patients (19.7%) underwent surgery during the pandemic. On average, patients during the pandemic were less socioeconomically distressed (DCI 37.4 vs DCI 41.9; P < .001) and had a lower STS predicted risk of mortality (2.16% vs 2.53%, P < .001). After risk adjustment, the pandemic was significantly associated with increased mortality (odds ratio 1.398; 95% CI, 1.179-1.657; P < .001), cost (+$4823, P < .001), and STS failure to rescue (odds ratio 1.37; 95% CI, 1.10-1.70; P = .005). The negative impact of the pandemic on mortality and cost was similar regardless of DCI.
Across all socioeconomic statuses, the pandemic is associated with higher cost and greater risk-adjusted mortality, perhaps related to a resource-constrained health care system. More patients during the pandemic were from less distressed communities, raising concern for access to care in distressed communities.
社会经济困境的加剧与心脏手术结果的恶化有关。大流行对心脏手术的可及性和结果的影响程度尚不清楚。我们试图通过社会经济地位来研究 COVID-19 大流行与心脏手术后结果之间的关系。
对在区域合作组织弗吉尼亚心脏服务质量倡议（2011-2022 年）中接受胸外科医师学会（STS）指数手术的所有患者进行分析。患者根据手术时间分为大流行前（2020 年 3 月 13 日）和大流行期间（分层。分层逻辑回归评估了大流行与手术死亡率、主要发病率和成本之间的关系，调整了困境社区指数（DCI）、STS 预测死亡率、术中特征和医院随机效应。
共纳入 17 个中心的 37769 名患者。其中，7269 名患者（19.7%）在大流行期间接受手术。平均而言，大流行期间的患者社会经济压力较小（DCI 为 37.4 与 DCI 为 41.9；P<.001），STS 预测死亡率较低（2.16%与 2.53%，P<.001）。在风险调整后，大流行与死亡率增加显著相关（优势比 1.398；95%CI，1.179-1.657；P<.001），成本增加（增加$4823，P<.001）和 STS 救援失败（优势比 1.37；95%CI，1.10-1.70；P=0.005）。无论 DCI 如何，大流行对死亡率和成本的负面影响是相似的。
在所有社会经济地位中，大流行与更高的成本和更大的风险调整死亡率相关，这可能与资源受限的医疗保健系统有关。大流行期间更多的患者来自压力较小的社区，这引起了人们对压力社区获得医疗保健的关注。
