European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
Association Between Social Vulnerability and Clinical Outcomes After Proximal Aortic Surgery.
СтатьяНазвание и аннотация: Перевод в очереди
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Harik Lamia, Leith Jordan, Rahouma Mohamed, Cancelli Gianmarco, Rossi Camilla Sofia, Soletti Giovanni, Balaram Sandhya K, Lau Christopher, Girardi Leonard, Gaudino Mario
Аннотация
OBJECTIVES: To evaluate the relationship between social vulnerability and proximal aortic surgery outcomes.
METHODS: Single-centre, social vulnerability index (SVI)-stratified, cohort study including all patients undergoing primary proximal aortic surgery from 1997 to 2023. Social vulnerability index was calculated by patient residential Zone Improvement Plan (ZIP) code. Outcomes of interest were postoperative major adverse events (operative mortality, myocardial infarction, stroke, reoperation, haemodialysis, and tracheostomy) and all-cause mortality at time of last registry assessment.
RESULTS: Of the 2002 patients, 659 (32.9%) had SVI <0.25, 727 (36.3%) had SVI 0.25to <0.50, 338 (16.9%) had SVI 0.50 to <0.75, and 278 (13.9%) had SVI ≥0.75. Patients with SVI ≥0.75 had more comorbidity (diabetes, smoking, chronic obstructive pulmonary disease, prior stroke, renal insufficiency, and New York Heart Association class III-IV heart failure), as well as more dissection at presentation and non-elective surgery, compared with lower-SVI patients. Operative mortality occurred in 8/2002 (0.40%) patients and the composite of major adverse events occurred in 99/2002 (4.9%) patients. On multivariable analysis, SVI was not significantly associated with major adverse events (odds ratio for SVI ≥0.75: 1.09, 95% confidence interval [CI] 0.56-2.06; P = .80). At median follow-up of 8.3 years (95% CI 4.3-14.0), 204 (10.2%) patients had died; patients with SVI ≥0.75 had the highest all-cause mortality (SVI <0.25: 49/659 [7.4%], SVI 0.25 to <0.50: 69/727 [9.5%], SVI 0.50 to <0.75: 41/338 [12.1%], SVI ≥0.75: 45/278 [16.2%]; P = .001). After multivariable adjustment for confounders, SVI was not significantly associated with all-cause mortality (hazard ratio for SVI ≥0.75: 1.29, 95% CI 0.90-1.85; P = 0.17).
CONCLUSIONS: Preoperative SVI is not independently associated with early or late outcomes after surgery of the proximal aorta, despite the most vulnerable patients having the highest long-term mortality.
METHODS: Single-centre, social vulnerability index (SVI)-stratified, cohort study including all patients undergoing primary proximal aortic surgery from 1997 to 2023. Social vulnerability index was calculated by patient residential Zone Improvement Plan (ZIP) code. Outcomes of interest were postoperative major adverse events (operative mortality, myocardial infarction, stroke, reoperation, haemodialysis, and tracheostomy) and all-cause mortality at time of last registry assessment.
RESULTS: Of the 2002 patients, 659 (32.9%) had SVI <0.25, 727 (36.3%) had SVI 0.25to <0.50, 338 (16.9%) had SVI 0.50 to <0.75, and 278 (13.9%) had SVI ≥0.75. Patients with SVI ≥0.75 had more comorbidity (diabetes, smoking, chronic obstructive pulmonary disease, prior stroke, renal insufficiency, and New York Heart Association class III-IV heart failure), as well as more dissection at presentation and non-elective surgery, compared with lower-SVI patients. Operative mortality occurred in 8/2002 (0.40%) patients and the composite of major adverse events occurred in 99/2002 (4.9%) patients. On multivariable analysis, SVI was not significantly associated with major adverse events (odds ratio for SVI ≥0.75: 1.09, 95% confidence interval [CI] 0.56-2.06; P = .80). At median follow-up of 8.3 years (95% CI 4.3-14.0), 204 (10.2%) patients had died; patients with SVI ≥0.75 had the highest all-cause mortality (SVI <0.25: 49/659 [7.4%], SVI 0.25 to <0.50: 69/727 [9.5%], SVI 0.50 to <0.75: 41/338 [12.1%], SVI ≥0.75: 45/278 [16.2%]; P = .001). After multivariable adjustment for confounders, SVI was not significantly associated with all-cause mortality (hazard ratio for SVI ≥0.75: 1.29, 95% CI 0.90-1.85; P = 0.17).
CONCLUSIONS: Preoperative SVI is not independently associated with early or late outcomes after surgery of the proximal aorta, despite the most vulnerable patients having the highest long-term mortality.