Key result
Social deprivation was an independent predictor of mid-term mortality after cardiac surgery (HR 1.024; 95% CI 1.015-1.033; P<0.001), even after adjusting for smoking, BMI, and diabetes.
Why the study?
Does social deprivation increase the risk of mortality in adults undergoing cardiac surgery?
Observational (n=44,902)
Yes
Does social deprivation increase the risk of mortality in adults undergoing cardiac surgery?
Social deprivation is an independent predictor of increased mid-term mortality after cardiac surgery, an effect that is only partially explained by modifiable risk factors like smoking, BMI, and diabetes.
Answers are grounded in this paper and cite their sources.
Social deprivation warrants consideration in cardiac surgery risk models; leaves open whether targeted interventions improve mid-term survival.
OBJECTIVE: To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. DESIGN: Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. SETTING: Birmingham and north west England. PARTICIPANTS: 44 902 adults undergoing cardiac surgery, 1997-2007. MAIN OUTCOME MEASURES: Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up. RESULTS: In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001). CONCLUSIONS: Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.
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Pagano et al. (2009) conducted an observational in cardiac surgery (n=44,902). Social deprivation was evaluated on All cause mortality at mid-term follow-up (HR 1.024, 95% CI 1.015-1.033, p=<0.001). Social deprivation was an independent predictor of mid-term mortality after cardiac surgery (HR 1.024; 95% CI 1.015-1.033; P<0.001), even after adjusting for smoking, BMI, and diabetes.
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