Association of Hospital and Physician Characteristics and Care Processes With Racial Disparities in Procedural Outcomes Among Contemporary Patients Undergoing Coronary Artery Bypass Grafting Surgery

Abstract

Background-Previous studies have reported that black patients undergoing coronary artery bypass surgery had worse outcomes than white patients, even after accounting for patient factors. The degree to which clinician, hospital, and care factors account for these outcome differences remains unclear. Methods and Results-We evaluated procedural outcomes in 11 697 blacks and 136 362 whites undergoing isolated coronary artery bypass surgery at 663 Society of Thoracic Surgery Database participating sites (January 1, 2010 to June 30, 2011) adjusted for patients' clinical and socioeconomic features, hospital and surgeon effects, and care processes (internal mammary artery graft and perioperative medications use). Relative to whites, blacks undergoing coronary artery bypass surgery were younger, yet had higher comorbidities and more adverse presenting features. Blacks were also more likely to be treated at hospitals with higher risk-adjusted mortality. The use of internal mammary artery was marginally lower in blacks than in whites (93.3% versus 92.2%, P<0.0001). Unadjusted mortality and major morbidity rates were higher in blacks than in whites (1.8% versus 2.5%, P<0.0001) and (13.6% versus 19.4%, P<0.0001), respectively. These racial differences in outcomes narrowed but still persisted after adjusting for surgeon, hospital, and care processes in addition to patient and socioeconomic factors (odds ratio, 1.17; 95% confidence interval, 1.00-1.36 and odds ratio, 1.26; 95% confidence interval, 1.19-1.34, respectively). Conclusions-The risks of procedural mortality and morbidity after coronary artery bypass surgery were higher among black patients than among white patients. These differences were in part accounted for by patient comorbidities, socioeconomic status, and surgeon, hospital, and care factors, as well, as suggested by the reduction in the strength of the race-outcomes association. However, black race remained an independent predictor of outcomes even after accounting for these differences.

The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Research

“…Another risk factor that has been historically associated with adverse outcomes after CABG is African-American race. In a recent study, Mehta and colleagues [17] compared 11,697 African-American patients with 136,362 white patients undergoing isolated CABG between 2010 and 2011 at 663 sites in the ACSD [17]. African-American patients undergoing CABG were significantly younger, more likely to be female, had a higher body mass index, and greater prevalence of comorbidities including hypertension, diabetes mellitus, smoking, peripheral vascular disease, cerebrovascular disease, use of immunosuppressive drugs, preoperative dialysis, myocardial infarction within 7 days of CABG, congestive heart failure, moderate to severe mitral regurgitation, and lower left ventricular ejection fraction compared with white patients.…”

“…This article reviews the major research efforts utilizing the ACSD that were published in 2016. Two studies analyzed patient outcomes in the ACSD to evaluate national trends in clinical practice [13,14], three studies assessed the effect of several risk factors on postoperative morbidity and mortality [15][16][17], and two studies developed new models to evaluate quality of care [18,19].…”

Preventing Disparities: Bayesian and Frequentist Methods for Assessing Fairness in Machine-Learning Decision-Support Models

“…In that connection, the impact of race/ethnicity on health services access, long-term risk factor control, and cardiovascular outcomes among patients has been the subject of intensive study for decades [75][76][77][78][79][80][81][82][83]. However, significant disparities in cardiovascular management have received less attention [84][85][86][87][88][89]. Similarly, the current literature has directed scant attention to disparities in cancer care subsequent to diagnosis.…”

Black Lives Do Matter

“…[1][2][3] This may be explained by the issues of lower volumes, experience with the procedure, and the ability to provide perioperative care that is at the same standard of the highest-ranked facilities with the lowest morbidity and mortality. Best practice standards that allow institutions to understand and achieve the appropriate highest levels of care should be in place, with the caveat that those who are unable to meet these standards should work toward establishing relationships with associate institutions that are in the highest quartile and where their patients can get the level of care required to maximize outcomes.…”

“…I n this issue of Circulation, Mehta and colleagues 1 provide additional information on the state of cardiovascular care for the black population in the United States and, once again, the results remain mixed in our ability to optimize care for all. Their data remain consistent with findings from Bridges et al 2 in 2000 in identifying race as an adverse factor for mortality for coronary artery bypass grafting and from Konety et al 3 in 2005 who found that the differences in morbidity and mortality outcomes worsened significantly over a 365-day period between blacks and whites in the data set.…”