WTP1.13 The A-HeAD Study: Effects of socio-economic deprivation on modifiable preoperative health behaviours and outcomes after aortic aneurysms repair. A retrospective review

Abstract

Abstract Aims Social Deprivation is associated with health inequalities and poor clinical outcomes. As yet outcomes for aneurysm surgery are not well understood. This study aims to explore the association of Abdominal Aortic Aneurysm (AAA) surgery and socio-economic status on postoperative complications and outcome. Methods All elective AAA repair (open and endovascular) performed between January 2015 and January 2020 at a tertiary vascular centre were analysed. Deprivation (index of multiple deprivation (IMD)) data was sourced from the English indices of deprivation 2019, by postcode. Primary outcome was overall survival by Kaplan-Meier. Secondary outcomes included comparison of pre-operative fitness assessments, and comorbidity. Clinical outcomes included length of hospital stay (LOS) and complications. Cox-proportional hazard analyses were conducted. Results Patients (n=472) were divided into two groups (IMD 1-3 (n=171) and IMD 4-10 (n=301)). Gender ratios were comparable, with similar AAA size, other co-morbidities and CPET assessment results. IMD 1-3 participants were younger (72.4(8.1) vs 74.6 (7.8), p=0.011), had higher smoking rates (61.4% vs 19.6%, P=0.03) and more frequent history of stroke (18.1% vs 11.3%, P=0.036). There was no difference in survival based upon IMD but patients from IMD 1-3 spent longer in level 2/3 care (2(2-3) vs 1(1-2), P=0.022) and experienced more re-admissions (14% vs. 6%. P=0.003). In addition, cox-regression indicated that patients without COPD were twice as likely to survive (HR 0.54 (0.31-0.94 P=0.03). Conclusion IMD was not associated with poor outcome. Smoking was more prevalent in lower IMD groups. As COPD was associated with increased likelihood of death, pre-operative optimisation can be targeted towards higher risk groups.