Impact of socioeconomic deprivation on early and long-term outcomes after major aortic surgery: insights from a 20-year single-centre cohort

BACKGROUND: Socioeconomic deprivation has been associated with adverse outcomes after aortic surgery, although evidence remains inconsistent. We assessed its impact on postoperative and long-term outcomes after major aortic surgery. METHODS: We included consecutive patients who underwent type A acute aortic dissection (TAAAD) repair or elective/urgent major aortic surgery between 2004 and 2025 at our institution. Socioeconomic status was determined using the Index of Multiple Deprivation (IMD) and patients were further categorised into most deprived (quintiles 1-3) and least deprived (quintiles 4-5). A secondary analysis evaluated outcomes across all five IMD quintiles. Postoperative outcomes and long-term survival were compared using univariable and multivariable models. RESULTS: The TAAAD cohort included 526 patients (median age 64 years; 34% female), with 250 (47.5%) classified as most deprived and 276 (52.5%) as least deprived. In-hospital mortality was significantly higher among the most deprived group (20% vs 12%, p=0.008), with deprivation independently associated with higher in-hospital mortality (OR 2.44, 95% CI 1.20 to 4.96). 10-year survival was also significantly reduced in the most deprived group (56.0% vs 69.4%, p