Disparities in cardiac arrest and failure to rescue after major elective noncardiac operations

Abstract

BackgroundContemporary large-scale studies examining demographic and surgical factors associated with perioperative cardiac arrest and its associated outcomes are sparse. MethodsAdults undergoing elective pancreatectomy, hepatectomy, lung resection, colectomy, gastrectomy, esophagectomy, abdominal aortic aneurysm repair, or hip replacement were identified between 2005 and 2018 using the National Inpatient Sample. Factors associated with cardiac arrest were of primary interest, while failure to rescue was also considered. Risk-adjusted outcomes were analyzed using logistic regressions to ascertain adjusted odds ratios as selected with Elastic Net methodology. ResultsOf an estimated 7,216,531 hospitalizations for major elective operations, 21,496 (0.3%) had cardiac arrest. The incidence of cardiac arrest decreased from 0.4% in 2005 to 0.3% in 2018, as did failure to rescue (65.4%−53.2%, P < .001). Factors including increased age (adjusted odds ratios: 1.02/year; 95% confidence interval, 1.01−1.02), higher Elixhauser comorbidity score (adjusted odds ratios: 1.46/point; 95% confidence interval, 1.44−1.49), abdominal aortic aneurysm repair (adjusted odds ratios: 1.67, 95% confidence interval, 1.25−2.23, reference: esophagectomy), and Black race (adjusted odds ratios: 1.60; 95% confidence interval, 1.43−1.80, reference: White) were independently associated with increased cardiac arrest. Furthermore, private insurance (private: adjusted odds ratios: 0.78; 95% confidence interval, 0.66−0.93, reference: Medicaid) and the highest income quartile (highest: adjusted odds ratios: 0.83; 95% confidence interval, 0.75−0.92, reference: lowest) were associated with lower adjusted odds of cardiac arrest. After cardiac arrest, Black race (adjusted odds ratios: 1.26; 95% CI, 1.02−1.56, reference: White) maintained increased adjusted odds of failure to rescue. ConclusionDespite a reduction in the incidence of cardiac arrest and an associated improvement in survival, racial and socioeconomic disparities influence outcomes. These findings may advise policy changes to encourage equity in outcomes for those undergoing major elective operations.