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Socioeconomic status and early outcome from coronary artery bypass grafting
  1. Patrick Gibson
  1. University of Aberdeen, United Kingdom
    1. Bernard Croal
    1. Aberdeen Royal Infirmary, United Kingdom
      1. Brian Cuthbertson
      1. University of Aberdeen, United Kingdom
        1. George Gibson
        1. Aberdeen Royal Infirmary, United Kingdom
          1. Robert Jeffrey
          1. Aberdeen Royal Infirmary, United Kingdom
            1. Keith Buchan
            1. Aberdeen Royal Infirmary, United Kingdom
              1. Hussein El-Shafei
              1. Aberdeen Royal Infirmary, United Kingdom
                1. Graham S Hillis (ghillis{at}george.org.au)
                1. University of Aberdeen, United Kingdom

                  Abstract

                  Objective: To determine the effects of socioeconomic status (SES) on the outcome of coronary artery bypass grafting (CABG).

                  Design: Prospective cohort study.

                  Setting: Regional cardiac surgical unit.

                  Patients: One thousand nine hundred and ninety four consecutive patients undergoing non-emergency CABG.

                  Measures: SES was determined from the patient’s postcode using Carstairs tables. The primary end-point was all-cause mortality at 30-days.

                  Results: There were 50 deaths (2.5%) within 30-days of surgery. A higher Carstairs score demonstrated a trend towards increased 30-day mortality (odds ratio [OR] 1.09 per unit, 95% confidence interval [CI] 1.00-1.20, p=0.06). In a backward conditional model, including other predictors of early mortality, Carstairs scores were independently predictive (OR 1.12 per unit, 95% CI 1.01-1.24, p=0.02). In a model including only Carstairs scores and the EuroSCORE both were independent predictors of this outcome (OR for Carstairs score 1.11 per unit, 95% CI 1.00-1.22, p=0.04). Thirty-day mortality increases in each quartile of Carstairs scores, with patients in quartile 4 (most deprived) at significantly higher risk compared to quartile 1 (uncorrected OR 2.53 per unit, 95% CI 1.04-6.15; OR corrected for EuroSCORE, 2.56 per unit, 95% CI 1.03-6.34, p=0.04 for both). Similarly, patients in the least affluent quartile were twice as likely to suffer a serious complication as those in the most affluent quartile (OR 2.14 per unit, 95% CI 1.32-3.46, p=0.002). This increased risk was also independent of the EuroSCORE.

                  Conclusions: Lower SES is associated with a poorer early outcome following CABG and is independent of other recognised risk factors.

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