Impact of Socioeconomic Status on Failure to Rescue Following Elective Cardiac Surgery

Abstract

Background

Failure to rescue (FTR), defined as mortality following a major postoperative complication, has emerged as a key quality metric in cardiac surgery. While socioeconomic disparities in surgical outcomes are well-documented, the relationship between socioeconomic status (SES) and FTR remains insufficiently characterized, particularly regarding which SES components most strongly drive this risk.

Methods

All adults experiencing a Society of Thoracic Surgeons-defined major complication following cardiac surgery were identified from the 2016-2022 Nationwide Readmissions Database. Patients were stratified into low-, middle-, and high-SES groups using a composite metric integrating payer status, neighborhood income quartile, and ICD-10-coded social determinants. Multivariable regression models were developed to examine the association between SES and FTR.

Results

Of an estimated 67,982 patients with major complications, 10,793 (15.9%) experienced FTR. FTR rates increased from 16.0% in 2016 to 18.4% in 2022 (nptrend<0.05), while complication incidence correspondingly declined. Following multivariable adjustment, low- and middle-SES were independently associated with increased odds of FTR compared to high-SES (AOR 1.33, 95% CI 1.19-1.48; AOR 1.18, 95% CI 1.07-1.30, respectively). Upon stratification by individual SES factors, the lowest income quartile consistently demonstrated increased FTR risk, whereas Medicaid status was not significantly associated with FTR.

Discussion

Socioeconomic status was independently associated with FTR in a dose-dependent manner. The stronger association with neighborhood income rather than insurance status suggests FTR disparities represent a geographically localized phenomenon. Targeted interventions focusing on communities where low-income patients are concentrated may yield greater impact than population-wide strategies.