Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea

Abstract Objectives Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival. Methods A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed. Results The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes. Key messages • This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission. • Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.