Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes

Abstract

To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P=.008), but not the multivariable regression model (P=.39). Postoperative hospital length of stay was significantly associated with COI (P<.001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30days of hospital discharge in univariable (P<.094) and multivariable (P=.49) models. COI is associated with postoperative hospital length of stay but not all outcomes in patients aftercongenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.