Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis

Abstract

Central message: Despite progress is being made in lowering in-hospital mortality rates among the major racial/ethnic groups, ethnical disparities in hospital mortality after coronary bypass surgery remain. 3 Prospective statement: The effect of race on mortality after coronary bypass surgery remains uncertain and current guidelines and risk stratification systems make no differentiation by race. We showed that despite progress is being made in lowering inhospital mortality rates among the major racial/ethnic groups, ethnical disparities in hospital mortality after CABG remain.

Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends

“…51 These observations are in keeping with other international evidence of inequities in postoperative mortality for minority racial/ethnic groups [52][53][54] : for example, a recent meta-analysis focussing on racial differences in coronary artery bypass graft procedures found that compared with white patients, black patients had a 25% increased risk of death in hospital when adjusted for both patient-level and hospital-level factors (OR 1.25, 95% CI 1.13 to 1.39). 55 The strong relationship observed between risk of death and patient comorbidity (and ASA level) is consistent with other large cohort studies. 39 The most straightforward explanation is that those with comorbidity are more likely to have complications and/or die shortly after surgery because they are simply sicker than those without comorbidity; however, this relationship is also likely to be influenced by procedure type within specialties (although the latter should have been largely accounted for when adjusting for procedure risk within our Cox models).…”

“… 51 These observations are in keeping with other international evidence of inequities in postoperative mortality for minority racial/ethnic groups 52–54 : for example, a recent meta-analysis focussing on racial differences in coronary artery bypass graft procedures found that compared with white patients, black patients had a 25% increased risk of death in hospital when adjusted for both patient-level and hospital-level factors (OR 1.25, 95% CI 1.13 to 1.39). 55 …”

Paying for better care?

“…Although the outcomes were adjusted for case-mix based on the EUROSCORE, several important confounding factors require further consideration. For example, the same authors have inspected a larger series of data, identifying an association with ethnicity [7] . Prior studies have examined body-mass index, BMI (demonstrating a U-shaped relationship with mortality), and socioeconomic status, including adjustment for BMI and smoking [ 8 , 9 ].…”

Commentary: The association of race with coronary artery bypass grafting mortality: A complex issue

“…In this issue of the Journal, Benedetto and colleagues 1 report their exploration of the association of race with operative mortality after coronary artery bypass grafting (CABG). The study's strengths include a large data set of real-world patient encounters, pairwise comparisons between races, as well as risk-adjusted analyses in studies where the data were provided.…”