Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative

Mazzeffi, Michael; Holmes, Sari D.; Alejo, Diane; Fonner, Clifford E.; Ghoreishi, Mehrdad; Pasrija, Chetan; Schena, Stefano; Metkus, Thomas S.; Salenger, Rawn; Whitman, Glenn J.R.; Ad, Niv; Higgins, Robert S.D.; Taylor, Bradley S.

doi:10.1016/j.athoracsur.2019.11.043

Cited by 19 publications

(10 citation statements)

References 20 publications

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“…Chaudhary et al proposed that universal access to healthcare may lessen racial disparities, but other research has suggested that postoperative care for Black patients may still be suboptimal. 29,30 Nevertheless, using a state-wide database, Mazzeffi et al 31 suggested that Black patients may do better than others postoperatively, a finding that differs from our national investigation. This study investigated data from Maryland which, as proposed by the authors, has an all-payer system that equitably reimburses hospitals, suggesting some uninsured or underinsured patients might have improved access to care.…”

Section: Discussioncontrasting

confidence: 84%

“…The proportion of uninsured nonelderly patients in Maryland is lower than the national average: 7.1% versus 10.2%. 31 More studies using large, robust clinical registries are needed to appreciate how socioeconomic and state-level factors may be contributing to poor health outcomes among minority patients. Similarly, we suggest that additional research should focus on multilevel modeling of these hospital, community, and local factors, as some research has previously suggested hospital-level factors can significantly contribute to outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery

et al. 2020

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Objective:The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG.Summary Background Data: Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated. Methods:We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission. Results:The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05-1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21-1.30). Conclusions:In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be ✉

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery

et al. 2020

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“…Racial disparities in cardiac outcomes are likely multifactorial. A large retrospective database of patients undergoing CABG surgery suggested that AA patients have a significantly higher prevalence of comorbidities including diabetes mellitus, hypertension, peripheral vascular disease, and cerebral vascular disease 22 . Studies have reported genetic and biologic differences in AA and Hispanics that may accelerate atherosclerotic disease progression and promote differential response to pharmaceutical interventions 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

et al. 2020

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Background Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African‐American (AA) patients. It remains unclear if the race is a predictor of outcomes among left ventricular assist device (LVAD) recipients. Methods Patients who underwent LVAD implantation between 2010 and 2017 were identified using the National Inpatient Sample. The race was classified as Caucasians vs AA vs Hispanics, and endpoints were in‐hospital outcomes, length of stay, and cost. Procedure‐related complications were identified via the International Classification of Diseases‐9 (ICD‐9) and ICD‐10 coding and analysis performed via mixed‐effect models. Results A total of 27 132 adults (5114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%), and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and mostly comorbidities, but lower rates of coronary artery disease and bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in stroke, bleeding complications, tamponade, infectious complications, acute kidney injury requiring hemodialysis, and in‐hospital mortality among racial groups. AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians, but similar cost of hospitalization. After adjustment for clinical comorbidities, race was not a predictor of in‐hospital mortality. Conclusion We identified differences in clinical characteristics but not in in‐hospital complications among LVAD recipients of a different races.

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“…The authors should be commended on discussing important contextual and regional factors associated with the findings, such as the rural setting, emergency transport system, and general demographics of Eastern North Carolina. Studies assessing racial disparities in cardiac surgery outcomes should be situated in the context within which patients present, and Allman and colleagues have done just that similar to others 4 . In today's world, though, we can no longer simply attribute differences in preoperative, intraoperative or postoperative characteristics to race without also commenting on ways in which patients are social beings whose health conditions emerge at the intersection of political, economic, or social circumstances, including the ways in which patients experience both implicit and explicit bias 5…”

mentioning

confidence: 98%

“…Studies assessing racial disparities in cardiac surgery outcomes should be situated in the context within which patients present, and Allman and colleagues have done just that similar to others. 4 In today's world, though, we can no longer simply attribute differences in preoperative, intraoperative or postoperative characteristics to race without also commenting on ways in which patients are social beings whose health conditions emerge at the intersection of political, economic, or social circumstances, including the ways in which patients experience both implicit and explicit bias. 5 One can almost always find some difference by race in conducting research with a retrospective registry and a large enough n. 6 In these types of analyses, though, race is being used as a surrogate for many other factors and variables that are not being collected, such as median household income, education level, occupation, health behavior-all of which are social phenomena and mediated and moderated by structural racism.…”

mentioning

confidence: 99%

Perils, paradigms, and possibilities: A commentary and recommendation on re‐evaluating racial disparities in cardiac surgery

Enumah

Kilic

2021

Journal of Cardiac Surgery

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Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative

Cited by 19 publications

References 20 publications

Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery

Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

Perils, paradigms, and possibilities: A commentary and recommendation on re‐evaluating racial disparities in cardiac surgery

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