Socioeconomic Status based on Area Deprivation IndexDoes Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Healthcare System
Karishma Setia, Diana Otoya, Sally Boyd, Kathryn Fong, Michael F Amendola, Kedar Lavingia
VA Medical Center/VCU, Richmond, VA
INTRODUCTION:
Research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage with a higher score associated with lower socioeconomic status. ADI has been scaled relative to a geographic region: local ADI (L-ADI; score 1 to 10) and national ADI (N-ADI; score 1 to 100). We set forth to identify the possible associations ADI score and post-operative outcomes after endovascular aneurysm repair (EVAR) in a VHA hospital.
METHODS:
Retrospectively analysis of EVAR patients from January 2010 to 2022. L-ADI and N-ADI were calculated with further stratification into quintile groupings. Patients clinical course was confirmed to account for percentage of loss to follow-up, 30-day and 1-year mortality.
RESULTS:
242 patients underwent EVAR over this period. 57.3% (n=138) and 47.3% (n= 114) of patients were in 4th of 5th L-ADI and N-ADI quintiles respectively. National ADI percentiles placed 47.3% (n= 114) in quintiles 4 and 5. Patient demographics, post operative complications, readmission rates and 1-year mortality did not statistically differ between local and national ADI scores nor among quintile groupings. 30-day mortality was statistically higher within the highest quintile L-ADI group (p=0.03**) but not for the same quintile N-ADI group (p=0.31**). Binary Logistic Regression showed no difference between the groups.
CONCLUSION:
There was no difference between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles except at 30-day mortality. This suggests the VHA resources and multidisciplinary support may improve care across low ADI neighborhoods with a critical window with the first 30 days after EVAR.
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