Abstract 12166: Social Determinants of Health and Acute Interstage Outcomes: An NPC-QIC Analysis

Introduction: The interstage period after Stage 1 palliation (S1P) carries high morbidity and mortality. The impact of social determinants of health (SDOH) on acute interstage outcomes has not been well described.

Question: How do SDOH affect interstage outcomes?

Methods: Infants discharged after S1P in the National Pediatric Cardiology Quality Improvement Collaborative Phase 2 registry were analyzed. ZIP code-level Childhood Opportunity Index (COI), a composite metric incorporating 29 indicators, was used to classify patients into 5 COI levels. Birth and S1P characteristics were compared. The association between COI level and binary acute interstage outcomes was assessed using log-rank test and logistic regression with and without adjustment for race/ethnicity, interstage risk factors, and interstage duration.

Results: There were 1837 patients from 68 centers. There were differences across COI levels in birthweight, proximity to a surgical center, area of residence, age and weight at S1P, S1P length of stay (LOS), and feeding mode at discharge ( Table ). Over 98% of patients in all COI levels had home monitoring. Death or transplant occurred in 101 (5%) patients with unplanned readmission in 987 (53%), ICU admission in 448 (24%), unplanned catheterizations in 345 (19%), and reoperation in 83 (5%). COI level was not associated with differences in interstage outcomes on logistic regression or log-rank test ( Figure) .

Conclusions: COI level is associated with differences in pre-operative status, feeding mode, and S1P LOS, but not acute interstage outcomes. The role of home monitoring programs in protecting against interstage disparities merits further investigation.