Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years

doi:10.1136/bmj.b902

Published 2 April 2009, doi:10.1136/bmj.b902
Cite this as: BMJ 2009;338:b902

Research

Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years

D Pagano, consultant and reader in cardiothoracic surgery¹, N Freemantle, professor of clinical epidemiology and biostatistics², B Bridgewater, consultant cardiothoracic surgeon³, N Howell, lecturer in cardiothoracic surgery¹, D Ray, head of informatics¹, M Jackson, associate director, quality improvement⁴, B M Fabri, consultant cardiothoracic surgeon⁵, J Au, consultant cardiothoracic surgeon⁶, D Keenan, consultant cardiothoracic surgeon⁷, B Kirkup, associate medical director⁸, B E Keogh, professor of cardiac surgery, NHS Medical Director⁹^,8, on behalf of the Quality and Outcomes Research Unit (QuORU) UHB Birmingham and the North West Quality Improvement Programme in Cardiac Interventions (UKNWQIP)

¹ Cardiothoracic Surgical Unit, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH , ² School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, ³ Department of Cardiothoracic Surgery, South Manchester University Hospital, Manchester M23 9LT, ⁴ Department of Clinical Quality, Liverpool Heart and Chest Hospital NHS Trust, Liverpool L14 3PE, ⁵ Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, ⁶ Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, ⁷ Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester M13 9WL, ⁸ Department of Health, London SW1A 2NS, ⁹ University College Hospital, London W1G 8PH

Correspondence to: D Pagano domenico.pagano{at}uhb.nhs.uk

Objective To assess the effects of social deprivation on survivalafter cardiac surgery and to examine the influence of potentiallymodifiable risk factors.

Design Analysis of prospectively collected data. Prognosticmodels used to examine the additional effect of social deprivationon 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 2001Carstairs scores. All cause mortality in hospital and at mid-termfollow-up.

Results In hospital mortality for all cardiac procedures was3.25% and mid-term follow-up (median 1887 days; range 1180-2725days) mortality was 12.4%. Multivariable analysis identifiedsocial 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 independentpredictors of mid-term mortality. The relation between BMI andmid-term mortality was non-linear and risks were higher in theextremes of BMI (P<0.001). Adjustment for smoking, BMI, anddiabetes reduced but did not eliminate the effects of socialdeprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001).

Conclusions Smoking, extremes of BMI, and diabetes, which arepotentially modifiable risk factors associated with social deprivation,are responsible for a significant reduction in survival aftersurgery, but even after adjustment for these variables socialdeprivation remains a significant independent predictor of increasedrisk of mortality.

© Pagano et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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