The association between the Distressed Communities Index and failure to rescue after cardiac surgery among Medicare beneficiaries.

BACKGROUND

Failure to rescue (FTR)-described as mortality after complications-is an important cardiac surgery quality metric. Although risk-adjusted FTR measures account for traditional patient risk, the impact of socioeconomic status on FTR is less understood.

METHODS

This sample included 67,386 Medicare beneficiaries undergoing coronary and/or valve surgery between 2016 and 2019. The Distressed Communities Index (DCI), a measure of neighborhood economic well-being, was linked to beneficiary ZIP code and stratified into quintiles for univariate analyses. Outcomes included complications, operative mortality, and in-hospital FTR. A composite of complications included renal failure, venous thromboembolism, pneumonia, gastrointestinal bleeding, pulmonary failure, hemorrhage, and surgical-site infections. Mixed-effects logistic regression assessed the association between DCI (per 10-point increase) and FTR.

RESULTS

The cohort was 31.6% female, 5.9% Black, and 1.3% Hispanic, with 24.1% in the lowest and 16.4% in the highest distressed quintiles. Beneficiaries in the highest versus lowest distressed quintile were younger as well as more likely female and minorities. The highest versus lowest DCI quintiles were more likely to undergo coronary artery bypass grafting. Beneficiaries in the highest distressed quintile had increased rates of composite complications (32.3% vs 28.9%, P < .001), mortality (5.3% vs 3.4%, P < .001), and FTR (12.0% vs 10.2%, P = .005). Adjusted odds of FTR were 2% greater (odds ratio, 1.02; 95% confidence interval, 1.00-1.04) per 10-point increase in DCI.

CONCLUSIONS

Residential DCI was predictive of FTR after cardiac surgery. Future work should identify and disseminate strategies to mitigate the disproportionate impact of low socioeconomic status on FTR.