Objective

We evaluated community socioeconomic (CSE) factors in patients who had unplanned readmission after undergoing proximal aortic surgery (ascending aorta, aortic root, or arch).

Methods

Unplanned readmissions for any reason within 60 days of the index procedure were reviewed by race, acuity at presentation, and gender. We also evaluated 3 CSE factors: poverty, household income, and education. Kaplan-Meier survival curves were used to assess long-term survival differences by group (race, acuity, gender).

Results

Among 2406 patients who underwent proximal aortic surgery during the 20-year study period and were discharged alive, our team identified 146 (6.1%) unplanned readmissions. Compared with White patients, Black patients lived in areas characterized by more widespread poverty (20.8% vs 11.1%, p=.0003), lower income (42,776 vs 65,193 USD, p=.0007), and fewer residents with a high school diploma (73.7% vs 90.1%, p <.0001). Compared with patients whose index operation was elective, patients who had urgent or emergency index procedures lived in areas with lower income (54,425 vs 64,846 USD, p=.01) and fewer residents with a high school diploma (81.1% vs 89.2%, p=.005). CSE factors did not differ by gender. Four- and 6-year survival estimates were 63.1% and 63.1% for Black patients versus 89.1% and 83.0% for White patients (p=.0009). No significant differences by acuity or gender were found.

Conclusions

Among readmitted patients, Black patients and patients who had emergency surgery had less favorable CSE factors and poorer long-term survival. Earlier and more frequent follow-up in these patients should be considered. Developing off-campus clinics and specific post-discharge measures targeting these patients is important.

中文翻译：

---

非计划再入院、社区社会经济因素及其对复杂胸主动脉手术后长期生存的影响

客观的

我们评估了接受近端主动脉手术（升主动脉、主动脉根或弓）后意外再入院的患者的社区社会经济（CSE）因素。

方法

索引程序后 60 天内因任何原因非计划再入院的情况按照种族、就诊时的敏锐度和性别进行审查。我们还评估了 3 个 CSE 因素：贫困、家庭收入和教育。Kaplan-Meier 生存曲线用于评估各组（种族、视力、性别）的长期生存差异。

结果

在 20 年研究期间接受近端主动脉手术并存活出院的 2406 名患者中，我们的团队发现了 146 名 (6.1%) 计划外再入院患者。与白人患者相比，黑人患者居住的地区贫困更加普遍（20.8% vs 11.1%，p=.0003）、收入较低（42,776 美元 vs 65,193 美元，p=.0007），并且拥有高中文凭的居民较少（73.7% 与 90.1%，p <.0001）。与择期进行指数手术的患者相比，接受紧急或急诊指数手术的患者居住在收入较低的地区（54,425 美元 vs 64,846 美元，p=0.01），并且拥有高中文凭的居民较少（81.1% vs 89.2%，p）。 =.005）。CSE 因素没有因性别而异。黑人患者的四年和六年生存率估计分别为 63.1% 和 63.1%，而白人患者则分别为 89.1% 和 83.0% (p=.0009)。没有发现敏锐度或性别之间存在显着差异。

结论

在重新入院的患者中，黑人患者和接受紧急手术的患者的 CSE 因素较差，长期生存率较差。应考虑对这些患者进行更早、更频繁的随访。针对这些患者建立校外诊所和具体的出院后措施非常重要。