The impact of safety-net burden on in-hospital outcomes after surgical aortic valve replacement.

Abstract

Surgical aortic valve replacement (SAVR) is the most common valvular surgery and thus needs to be widely available including minorities and socially disadvantaged patients. SAVR outcomes at safety-net hospitals, which serve a high percentage of these patients, are limited. We aimed to compare the outcomes of SAVR at different safety-net burden hospitals. Nationwide Inpatient Sample from 2005 to 2011 was queried to identify SAVR performed for over the age of 50. The safety-net burden of hospitals was calculated as the number of admission to a hospital in a year who were uninsured or insured by Medicaid divided by the total number of admissions for the respective year. Hospitals were categorized into quintiles of safety-net rate and then into three categories based on the safety-net burden (low burden hospitals [LBHs], lowest quintile, medium burden hospitals [MBHs], 2nd-4th quintiles; and high burden hospitals [HBHs], highest quintile). A total of 85 441 SAVR were included. In unadjusted models, in-hospital mortality was higher in HBHs compared with LBHs but became nonsignificant after adjustments for patient and hospital-level characteristics. Major perioperative complications and hospital costs were similar, but hospital stay was longer at HBHs compared with LBHs. At MBHs, acute kidney injury requiring dialysis and bleeding requiring transfusion was lower compared with LBHs. Length of stay and cost were shorter and lower at MBHs compared with LBHs. Nonroutine discharge was similar for HBHs and MBHs compared with LBHs. SAVR outcomes are reassuring at MBHs and HBHs.