The Effect of Socioeconomic Status on Patients Undergoing Elective Abdominal Aortic Aneurysm Repair in a Publicly Funded Healthcare System

Abstract

The association between socioeconomic status (SES) and outcomes after abdominal aortic aneurysm (AAA) repair has been poorly described in the context of a publicly funded health system. The purpose of the present study was to determine the effect of SES on short- and long-term mortality and morbidity in AAA repair patients in the province of Nova Scotia, Canada. A retrospective analysis of all elective AAA repairs in Nova Scotia from 2005 to 2015 was performed using the Discharge Abstract Database and provincial physician billing codes. Postoperative 30-day outcomes and long-term survival were compared across socioeconomic quintiles, defined by the Material Deprivation Index (MDI). Postoperative outcomes included mortality, stroke, myocardial infarct, length of stay, and discharge to home. The relationship among the baseline characteristics, MDI, and 30-day mortality were analyzed using univariable logistic regression. Multivariable logistic regression and survival analysis were used to calculate the adjusted 30-day mortality and long-term survival, respectively. A total of 1829 patients underwent AAA repair from 2005 to 2015. The 30-day outcomes, including death (P = .910), stroke (P = .749), myocardial infarct (P = .061), length of stay (P = .3488), and discharge to home (P = .847) were similar across the MDI quintiles After adjusting for variables significant on univariable analysis (ie, age, sex, history of stroke, and open vs endovascular approach), multivariable analysis revealed age >70 years (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.51-3.84; P < .001), history of stroke (OR, 2.21; 95% CI, 1.27-3.94; P = .006), and endovascular approach (OR, 0.18; 95% CI, 0.09-0.38; P < .001) but not MDI (P = NS) were associated with increased 30-day mortality. MDI quintile had no effect on long-term survival on univariable or multivariable analysis (Fig). SES does not appear to affect short- or long-term mortality after AAA repair in a publicly funded healthcare system.