Trends in mortality among the geriatric population undergoing Surgical aortic valve replacement (SAVR) and potential racial disparities: a 20-year perspective via the National (Nationwide) Inpatient Sample.

BACKGROUND

Racial disparities in cardiovascular conditions are well documented. Whether similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis remains understudied.

METHODS

We abstracted data from the National (Nationwide) Inpatient Sample over a 20-year period from 2001 to 2020 using specific ICD-9 and ICD-10 codes. We included patients aged ≥ 60 and ≤ 80 years with races recorded as White, African American, or Hispanic at the time of their hospitalization for surgery. We analyzed and reported the baseline characteristics, risk-adjusted in-hospital mortality, and complications stratified by race.

RESULTS

Of 420,181 patients studied, 90.0% identified as White, 4.0% as African American and 6.0% as Hispanic. Despite a decrease in overall in-hospital mortality rates from 3.8% between 2001-2005 to 1.8% between 2016-2020, African Americans had higher odds of all-cause in-hospital deaths compared to Whites (aOR = 1.390, < 0.001). Additionally, they were more likely to experience cardiogenic shock (aOR = 1.241, < 0.001) and acute kidney injury (aOR = 1.314, < 0.001) as well as more likely to require organ support such as IABP use (aOR = 1.336, < 0.001) or invasive mechanical ventilation (aOR = 1.342, < 0.001). Interestingly, African Americans were less likely to report events of acute ischemic stroke compared to Whites (aOR = 0.852, < 0.001).

CONCLUSIONS

Despite a reassuring reduction in overall in-hospital mortality rates of geriatric patients undergoing SAVR for aortic stenosis, racial disparities in health outcomes remain pervasive with minorities more likely to report higher in-hospital morbidity and mortality.