The association of upward economic mobility with textbook outcomes among patients undergoing general and cardiovascular surgery

Abstract

BackgroundWhile disadvantaged neighborhoods may be associated with worse outcomes and earlier death, the relationship between economic opportunity and surgical outcomes remains unexplored. MethodsMedicare beneficiaries who underwent AAA, CABG, colectomy or cholecystectomy were identified and stratified into quintiles based on upward economic mobility. Risk-adjusted probability of adverse postoperative outcomes were examined relative to economic mobility. ResultsAmong 1,081,745 Medicare beneficiaries (age: 75.5 years, female: 43.0%, White: 91.3%), risk-adjusted 30-day postoperative mortality decreased in a stepwise fashion from 6.0%(5.9–6.1) in the lowest quintile of upward economic mobility to 5.3%(5.2–5.4) in highest upward economic mobility (lowest vs. highest economic mobilityobility OR:1.14 (95%CI:1.11–1.17)). Similar associations were noted for postoperative complications (OR:1.04, 95%CI:1.02–1.06), extended length-of-stay (OR:1.07, 95%CI:1.06–1.09), and 30-day readmission (OR:1.04, 95%CI:1.02–1.05). Black beneficiaries had a higher risk of post-operative mortality across upward economic mobility quintiles except within the highest upward mobility group (referent, White patients, OR:0.93, 95%CI:0.79–1.09, p=0.355). ConclusionEconomic upward mobility was associated with post-operative outcomes. Race-based differences were mitigated at the highest levels of upward economic mobility, highlighting the importance of socioeconomics as a health equity lever.