Survival after AAA repair is affected by socioeconomic status
Al Adas Z, Shepard A, Nypaver TJ, Weaver M, Balraj P, Huang J, Harriz R, and Kabbani L. Survival after AAA repair is affected by socioeconomic status. J Vasc Surg 2017; 66(2):E21.
J Vasc Surg
Objectives The association between socioeconomic status (SES) and outcome after abdominal aortic aneurysm (AAA) repair is largely unknown. This study aimed to determine the influence of SES on postoperative survival after either open or endovascular AAA repair.
Methods All patients undergoing surgical treatment for their AAA at a tertiary referral center between January 1993 and July 2013 were retrospectively included and analyzed. Thirty-day postoperative mortality and long-term survival were documented through medical record review and the Michigan Social Security Death Index. SES was quantified using the Messer neighborhood deprivation index, which is a standardized and reproducible index used in research that summarizes eight domains of socioeconomic deprivation. The association between SES and survival was studied using univariate and multivariate Cox regression analysis.
Results A total of 767 patients were included. Patients were a mean age of 73 years, 80% were male, 78% were Caucasian, and 20% were African American. There was no difference in SES between patients who underwent open vs endovascular repair of their AAA ( P = .489). Univariate Cox regression analysis showed the Messer index was not associated with increased 30-day mortality ( P = .561; hazard ratio [HR], 1.39 [0.45, 4.27]) but was associated with decreased long-term survival ( P <.001; HR, 1.35 [1.18, 1.54]). After adjusting for other medical comorbidities, the association between the Messer index and long-term survival was still significant ( P = .003; HR, 1.28 [1.09, 1.50]).
Conclusions Long-term mortality but not short-term mortality after AAA repair is influenced by SES. Further studies are required to assess what risk factors (behavioral or psychosocial) are responsible for this decreased survival in low SES patients after AAA repair.