Faculty Collaboration Database

Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative. Ann Thorac Surg 2020 Aug;110(2):531-536

Date

01/22/2020

Pubmed ID

31962111

DOI

10.1016/j.athoracsur.2019.11.043

Scopus ID

2-s2.0-85079841420 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

BACKGROUND: Racial disparities persist in health care. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland.

METHODS: A statewide database was used to identify patients. Demographics, comorbidities, and predicted risk of death were compared between races. Crude mortality and incidence of complications were compared between groups, as were risk-adjusted odds for mortality and major morbidity or mortality.

RESULTS: The study included 23,094 patients. Most patients were white (75.8%), followed by African American (16.3%), Asian (3.8%), and other races (4.1%). African Americans had a higher preoperative risk for mortality based on The Society of Thoracic Surgeons predictive models compared with white patients (3.0% vs 2.3%, P < .001). African Americans also had higher prevalence of diabetes mellitus, hypertension, peripheral vascular disease, and cerebral vascular disease than white patients. After adjustment for preoperative risk, there was no difference in 30-day mortality between African Americans (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.99-1.59), Asians (OR, 1.22; 95% CI, 0.75-1.97), and other races (OR, 1.18; 95% CI, 0.74-1.89) compared with whites. African Americans had lower risk-adjusted odds of major morbidity or mortality compared with whites (OR, 0.83; 95% CI, 0.75-0.93).

CONCLUSIONS: African American cardiac surgical patients have the highest preoperative risk in Maryland. Patients appeared to receive excellent cardiac surgical care, regardless of race, as risk-adjusted mortality did not differ between groups, and African American patients had lower risk-adjusted odds of major morbidity or mortality than white patients. Future interventions in Maryland should be aimed at reducing preoperative risk disparity in cardiac surgical patients.

Author List

Mazzeffi M, Holmes SD, Alejo D, Fonner CE, Ghoreishi M, Pasrija C, Schena S, Metkus T, Salenger R, Whitman G, Ad N, Higgins RSD, Taylor B, Maryland Cardiac Surgery Quality Initiative (MCSQI)

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cardiac Surgical Procedures
Female
Follow-Up Studies
Heart Diseases
Humans
Male
Maryland
Middle Aged
Morbidity
Postoperative Complications
Quality Improvement
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate