Impact of social determinants of health on perioperative and interstage outcomes in congenital heart surgery a systematic review.

IMPORTANCE

Social determinants of health (SDoH)- conditions in which patients live, grow, and age,-are increasingly recognized to influence the health of patients with congenital heart disease (CHD).

OBJECTIVE

To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery.

EVIDENCE REVIEW: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria incorporated prior systematic reviews and meta-analyses, secondary analyses of prospectively collected trial data, and prospective or retrospective cohort studies. Subsequent reference searches identified 39 related articles. SDoH included patient and neighborhood level metrics. Two independent reviewers screened studies for full-text review, with data extraction by an expert panel.

FINDINGS: Among 1,224 studies identified, 157 articles underwent full-text review and 121 were ultimately selected for data extraction. Eighty-Five articles did not address acute postoperative outcomes and were excluded. Thirty-six studies focused on acute or interstage outcomes following congenital heart surgery and served as the source information. The remainder were retrospective cohort studies using various databases. The number of study participants ranged from 98 to 174,352 (median = 6,979). Factors found to be linked with greater likelihood of in-hospital mortality included Black race, Hispanic/Latino ethnicity, Medicaid insurance, and lower neighborhood socioeconomic status. Both individual and neighborhood level determinants were associated with longer interstage periods, higher complication rates, as well as greater resource utilization and hospital readmissions. Two critical timespans for intervention to reduce inequities in care were the neonatal period and young adulthood.

CONCLUSIONS AND RELEVANCE: SDoH impact both acute and interstage outcomes in patients following surgery for CHD. Developing interventions to increase access to and engagement with quality care and out-of-hospital support may improve both short-term outcomes and reduce systems-level financial burden. Systematic Review Registration.