Does Transcatheter Aortic Valve Replacement Overcome the Negative Impact of Distressed Socioeconomic Status?
Michael P. Rogers1, Haroon Janjua2, Sujay Kulshrestha3, Paul C. Kuo1, Lucian Lozonschi4
1Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA, 2University of South Florida Morsani College of Medicine, Tampa, FL, USA, 3Loyola University Medical Center, Chicago, IL, USA, 4Division of Cardiothoracic Surgery and Transplantation, University of South Florida Morsani College of Medicine, Tampa, FL, USA
BACKGROUND: Patients of low socioeconomic status have increased risk of complications following cardiac surgery. Recent analysis demonstrated worse outcomes following CABG in this cohort. We aimed to identify similar disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. METHODS: The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (SAVR, TAVR) between 2012 and 2015. Patient records were linked to the Distressed Communities Index. Patients undergoing TAVR and SAVR were propensity matched and stratified based on quintile of Economic Innovation Group DCI score. A distressed community was defined as those in quintiles 4 (Q4) and 5 (Q5), a non-distressed community was defined as those in quintiles 1 (Q1) and 2 (Q2). Outcomes following aortic valve replacement were compared across groups in distressed communities. RESULTS: A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group, of which 1,330 SAVR and 1,355 TAVR patients were in Q4/Q5. Overall, TAVR patients had a shorter length of stay (7.7 vs 11.9 days, p<0.001), and fewer cases of post-operative sepsis (96 vs 223 patients, p<0.001), pneumonia (209 vs 450 patients, p<0.001), and cardiac complications (442 vs 784 patients, p<0.001) than overall SAVR. Distressed Q4/Q5 TAVR vs SAVR patients mimicked these findings. When comparing distressed Q4/Q5 SAVR and TAVR and low distressed Q1/Q2 SAVR and TAVR groups, no significant difference was found in post-operative outcomes, except distressed Q4/Q5 TAVR experienced more cases of UTI (78 vs 55 patients, p<0.001). CONCLUSIONS: Overall, TAVR patients had fewer episodes of post-operative sepsis, pneumonia, and cardiac complications as compared to SAVR. There was no difference in outcomes in highly distressed groups regardless of surgical approach. Patients undergoing TAVR in highly distressed communities had an increased incidence of post-operative urinary tract infection.