Racial, ethnic, and sex disparities in the utilization and outcomes of tricuspid valve surgery

Abstract Background Data on racial/ethnic and sex disparities in the utilization and outcomes of tricuspid valve surgery (TVS) in the United States are scarce. Purpose We aimed to evaluate the impact of race/ethnicity and sex on the utilization and outcomes of TVS. Methods We analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for tricuspid valve surgery. Racial/ethnic and sex disparities in tricuspid valve surgery outcomes were determined using logistic regression models. Results Between 2016 and 2020, 19,395 hospitalizations for tricuspid valve surgery were identified. The utilization rates (defined as the number of tricuspid valve surgery performed per 100,000 US hospitalizations) were lower in Black and Hispanic patients compared with White patients for surgical tricuspid valve repair (331 versus 493 versus 634, p<0.01) and surgical tricuspid valve replacement (312 versus 601 versus 728, p<0.01). Similarly, the utilization rates were lower for women compared with men for surgical tricuspid valve repair (1,021 versus 1,364, p<0.01) and surgical tricuspid valve replacement (930 versus 1,316, p<0.01). Compared to White men undergoing tricuspid valve surgery, all women had lower odds of acute kidney injury (aOR 0.65, 95% CI 0.55-0.78) and higher odds of blood transfusion (aOR 1.30, 95% CI 1.07-1.59), and Black men had higher odds of blood transfusion (aOR 1.59, 95% CI 1.08-2.35). In-hospital mortality and other surgical complications were similar between all groups (all p>0.05). Conclusions Significant racial/ethnic and sex disparities exist in the utilization of tricuspid valve surgery in the United States. Further studies are needed to understand the reasons for these disparities and to identify effective strategies for their mitigation.