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The effect of race on coronary bypass operative mortality
C R Bridges1, F H Edwards, E D Peterson
1Department of Surgery, the University of Pennsylvania Health System, Philadelphia, USA. cbridges@mail.med.upenn.edu
Insights
Black race independently predicts operative mortality after coronary artery bypass graft (CABG) surgery, particularly in lower-risk men. However, referral decisions for CABG should prioritize clinical factors over race.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Outcomes Research
Background:
- Black patients are referred for cardiac procedures less often than white patients.
- Limited research exists on racial differences in outcomes after coronary artery bypass graft (CABG) surgery.
- Understanding race as a predictor of surgical outcomes is crucial for equitable care.
Purpose of the Study:
- To determine if race is an independent predictor of operative mortality following coronary artery bypass graft (CABG) surgery.
- To investigate the influence of race on risk-adjusted mortality after CABG.
- To identify potential disparities in CABG outcomes based on race.
Main Methods:
- Retrospective analysis of the Society of Thoracic Surgeons National Database.
- Inclusion of 25,850 black and 555,939 white patients undergoing CABG-alone (1994-1997).
- Development of a multivariate logistic regression model to assess the impact of race on operative mortality, controlling for risk factors.
Main Results:
- Unadjusted operative mortality was higher in black patients (3.83%) compared to white patients (3.14%).
- Race remained a significant independent predictor of mortality after adjusting for preoperative risk factors (adjusted OR 1.29).
- Mortality differences were most pronounced in lower-risk patients and male patients, with no significant difference observed in female patients.
Conclusions:
- Black race is an independent predictor of operative mortality after CABG, except in very high-risk individuals.
- The observed mortality difference, while statistically significant, is small in absolute terms.
- Patient referral for CABG should be based on clinical need, irrespective of race, to ensure equitable access to care.
Objectives:
The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery.
Background:
Blacks are less frequently referred for cardiac catheterization and CABG than are whites. Few reports have investigated the relative fate of patients who undergo CABG as a function of race.
Methods:
The Society of Thoracic Surgeons National Database was used to retrospectively review 25,850 black and 555,939 white patients who underwent CABG-alone from 1994 through 1997. A multivariate logistic regression model was developed to determine whether race affected risk-adjusted operative mortality.
Results:
Operative mortality was 3.83% for blacks versus 3.14% for whites (unadjusted black/white odds ratio [OR] 1.23 [1.15-1.31]). Blacks were younger, more likely female, hypertensive, diabetic and in heart failure. Nonetheless, the influence of these and other preoperative risk factors on procedural mortality was quite similar in black and white patients. After controlling for all risk factors, race remained a significant independent predictor of mortality in the multivariate logistic model (adjusted black/white OR 1.29 [1.21, 1.38]). Proportionately, these differences were greatest among lower-risk patients. The race-by-gender interaction was significant (p<0.05). The unadjusted mortality for black men, 3.30% and white men, 2.64% differed significantly (p<0.05), whereas for women there was no difference (black, 4.49%; white 4.41%).
Conclusions:
Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race.
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