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Sociodemographic Determinants Of Hospital Admission And Follow-up In Aortic Dissection: A Two-center Retrospective Cohort Study
Jonah Klapholz, BS, Ian Jaffe, BS, Leslie James, MD, Katherine Teter, MD, Joanelle Lugo, MD.
NYU Grossman School of Medicine, NY, NY, USA.
Objective: Ascending and descending aortic dissection (AD) carry significant morbidity and mortality and often require surgery up front as well as consistent follow-up in clinic. The aim of this retrospective analysis is to evaluate the demographics and characteristics of patients with AD who were offered surgery on admission and those who presented for follow-up. The goal of this study is to identify barriers to care in AD to better mitigate complications in vulnerable populations.
Methods: Patients over 18 years old with a history of ascending or descending AD diagnosed between January 2015 and May 2023 were selected randomly at two New York City hospitals. Electronic medical records were reviewed for demographics, comorbidities, hospital course, and follow-up. Univariate and multivariate analyses were conducted to compare patients who underwent surgery on admission to those who did not, as well as follow-up and non-follow-up cohorts.
Results: 122 patients were included. In the ascending group (n = 68), surgery on admission was associated with Hispanic/Latinx ethnicity (p = 0.05), diabetes (p < 0.05), and younger age (p < 0.05). Follow up in the ascending group was also linked to younger age (p < 0.001) along with longer hospital LOS (p < 0.05). In the descending group (n = 54), there was no association between surgery on admission with ethnicity, race, or age, though patients with a history of substance abuse skewed into the non-follow-up cohort (p < 0.05). In the whole sample analysis, patients who followed up were significantly younger (p < 0.001) and had higher BMI (p < 0.05). A significantly higher number of patients on public insurance followed up compared to patients with private or union insurance (p < 0.05). Patients who underwent surgery on admission also skewed into the follow-up cohort (p < 0.05). There was no association between sex, ethnicity, race, English consent language, comorbidities, and dissection type with follow-up.
Conclusions: Younger age impacted surgery upon admission and clinic follow-up in the ascending group and influenced follow-up across the whole sample. In the ascending group, Hispanic/Latinx ethnicity affected surgery on admission and hospital LOS determined follow-up. Reduced follow-up in the descending group was linked to substance abuse. Insurance status affected follow-up in the whole sample. Further studies are needed to validate these findings.
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