Low socioeconomic status adversely influences outcomes after coronary artery bypass grafting.

Abstract

Although socioeconomic status (SES) is believed to affect patient outcomes after coronary artery bypass grafting (CABG), readmission data are sparse. In a national cohort, we analyzed the influence of SES on readmission, resource utilization, and mortality after CABG. We queried the Nationwide Readmissions Database to identify patients who underwent isolated CABG from January 2016 through December 2018. We derived low, middle, and high SES from International Classification of Diseases, 10th Revision, Clinical Modification codes, patient demographics, and neighborhood-level factors. The effect of SES on risk-adjusted outcomes was assessed with multivariable analysis. Of 523,042 patients who underwent CABG, the 134,039 (25.6%) with low SES were more likely than patients with middle (n = 305,572 [58.4%]) or high SES (n = 83,431 [16%]) to be female, younger, from rural areas, and admitted urgently. Patients with low SES were also less likely to be treated at teaching hospitals and had higher Elixhauser comorbidity scores (P < .001 for all). After risk adjustment, patients with low SES had 46% greater odds of in-hospital mortality at the index operation (odds ratio, 1.464; 95% CI, 1.299-1.650) than patients with high SES. Patients with low SES had the longest index hospital length of stay (P < .001). Low SES was associated with greater odds of readmission at 30 days (odds ratio, 1.229; 95% CI, 1.170-1.292), 90 days (odds ratio, 1.281; 95% CI, 1.223-1.341), and within a calendar year (hazard ratio, 1.234; 95% CI, 1.193-1.278) than high SES. Patients with low SES have greater adjusted odds of mortality and readmission after CABG than patients with high SES.