Abstract 4359485: Impact of Social Determinants of Health on Emergency Department Use Following Congenital Heart Surgery

Background: Emergency department utilization is common for patients with congenital heart disease (CHD) after congenital heart surgery. Children with CHD who present to the ED are more likely to require hospitalization, incur higher healthcare costs, and experience worse outcomes compared to children without CHD. The impact of social determinants of health (SDOH) on ED utilization following CHD surgery is not well described. Our objective was to evaluate the relationship between SDOH and ED utilization in children within 12 months following CHD surgery. Methods: This is a retrospective cohort study of all patients, aged 0-21 years, who underwent cardiac surgery at Primary Children’s Hospital between 2014 and 2023. Patients were categorized by the number of ED visits following surgery (0, 1, 2-3, or 4+) and by disposition from ED. Associations between SDOH and ED utilization and disposition were evaluated using ordinal logistic regression with generalized estimating equations to account for within-subject correlation due to multiple surgeries per patient and multiple ED visit per surgery. Results: Among 3,858 surgeries analyzed (43% female, mean age 3.3 years) a higher ED utilization was associated with Black/African American and Native Hawaiian or other Pacific Islander (p=0.007 and <0.001, respectively), Hispanic/Latino ethnicity (P=0.01), and languages other than English or Spanish (p=0.007). Patients with more ED visits were more likely to be younger at time of surgery (p=0.015), publicly insured (p<0.001) and reside in areas with lower child opportunity index (COI) (p=0.008). Number of ED visits was not associated with either distance to the main hospital ED or to the presenting ED. Higher STAT mortality category and single ventricle status were not associated with more ED visits but were associated with admission or transfer when presenting to ED (p<0.001). Patients who were Hispanic/Latino, lived in areas with lower COI or had public insurance were more likely to be discharged from the ED, while patients from rural areas were more likely to be admitted. Results are summarized in Tables I and II. Conclusion: ED utilization following CHD surgery is associated with markers of socioeconomic vulnerability, including race, ethnicity, language, and childhood opportunity index as well as proximity to familiar emergency departments. These findings highlight the need for targeted discharge interventions and planning for these groups at higher risk of ED utilization.