ORCID

0000-0002-2254-5680 (Aughtman)

Document Type

Article

Publication Date

2026

DOI

10.3389/fcvm.2026.1881839

Publication Title

Frontiers in Cardiovascular Medicine

Volume

13

Pages

1881839 (15 pp.)

Abstract

Importance: Social determinants of health (SDoH)- conditions in which patients live, grow, and age, - are increasingly recognized to influence the health of patients with congenital heart disease (CHD).

Objective: To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery.

Evidence Review: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria incorporated prior systematic reviews and meta-analyses, secondary analyses[GJP1.1] of prospectively collected trial data, and prospective or retrospective cohort studies. Subsequent reference searches identified 39 related articles. SDoH included patient and neighborhood level metrics. Two independent reviewers screened studies for full-text review, with data extraction by an expert panel.

Findings: Among 1,224 studies identified, 157 articles underwent full-text review and 121 were ultimately selected for data extraction. Eighty-Five articles did not address acute[GJP2.1] postoperative outcomes and were excluded. Thirty-six studies focused on acute or interstage outcomes following congenital heart surgery and served as the source information. The remainder were retrospective cohort studies using various databases. The number of study participants ranged from 98 to 174,352 (median = 6979). Factors found to be linked with greater likelihood of in-hospital mortality included Black race, Hispanic/Latino ethnicity, Medicaid insurance, and lower neighborhood socioeconomic status. Both individual and neighborhood level determinants were associated with longer interstage periods, higher complication rates, as well as greater resource utilization and hospital readmissions. Two critical timespans for intervention to reduce inequities in care were the neonatal period and young adulthood.

Conclusions and Relevance: SDoH impact both acute and interstage outcomes in patients following surgery for CHD. Developing interventions to increase access to and engagement with quality care and out-of-hospital support may improve both short-term outcomes and reduce systems-level financial burden.

Rights

© 2026 Sakowitz, Nelson, Robinson, Rossi, Shahian, Cooke, Jacobs, Aughtman, Schultz, Nathan, Beaty, Shafer, Kozik and Pelletier.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Data Availability

Article states: "The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s."

Original Publication Citation

Sakowitz, S., Nelson, J. S., Robinson, J., Rossi, C., Shahian, D. M., Cooke, D. T., Jacobs, J., Aughtman, S., Schultz, M., Nathan, M., Beaty, C., Schafer, M., Kozik, D., & Pelletier, G. J. (2026). Impact of social determinants of health on perioperative and interstage outcomes in congenital heart surgery a systematic review. Frontiers in Cardiovascular Medicine, 13, Article 1881839. https://doi.org/10.3389/fcvm.2026.1881839

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