• William L Patrick, Markian Bojko, Jason J Han, John J Kelly, Amit Iyengar, Mark Helmers, Benjamin Smood, Fenton H McCarthy, and Matthew L Williams.
• Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pa; Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, Pa.
• J. Thorac. Cardiovasc. Surg. 2022 Jul 1; 164 (1): 92-102.e8.

ObjectiveWe sought to characterize differences in operative management and surgical outcomes after coronary artery bypass grafting associated with the socioeconomic context in which a patient lives.MethodsWe used a validated index of 17 variables derived from the US Census Bureau to assign socioeconomic status at the block group level to patients who underwent isolated coronary artery bypass grafting at a single institution over a 16-year period. Operative mortality, stroke, renal failure, prolonged ventilation, sternal wound infection, reoperation, composite morbidity or mortality, long-term survival, and use of arterial conduits were the outcomes assessed.ResultsThis study was composed of 6751 patients. Lower socioeconomic status was significantly associated with increased rates of stroke, renal failure, prolonged ventilation, and composite morbidity or mortality in a multivariable analysis. Low socioeconomic status was significantly associated with poorer long-term adjusted survival (hazard ratio, 1.26; 95% confidence interval, 1.03-1.55). Finally, lower socioeconomic status was significantly associated with decreased use of more than 1 arterial conduits in a multivariable analysis.ConclusionsThe socioeconomic context in which a patient lives is significantly associated with short- and long-term outcomes after coronary artery bypass grafting. There may also be variation in operative management, demonstrated by decreased use of arterial conduits. Lower rates of arterial revascularization among socioeconomically disadvantaged patients who undergo coronary artery revascularization may provide a target for intervention.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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