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Coronary artery bypass surgery: are outcomes influenced by demographics or ability to pay?
M C Mancini1, E M Cush, K Sweatman
1Department of Surgery, Division of Cardiothoracic Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA. mmanci@lsuhsc
Insights
Financially challenged patients undergoing coronary artery bypass surgery (CABG) in public hospitals show similar early survival but better late survival compared to insured patients. Access to care and outcomes are equitable, despite higher tobacco use in the uninsured group.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Health Disparities
Background:
- Coronary artery bypass surgery (CABG) is a high-cost, frequent procedure in the US.
- Concerns exist regarding equitable access to quality cardiac care for indigent and minority populations.
- This study investigates whether demographics or socioeconomic factors influence CABG outcomes.
Purpose of the Study:
- To analyze the relationship between financial status, demographics, and outcomes of coronary artery bypass surgery (CABG).
- To evaluate if socioeconomic factors or patient demographics impact CABG results in a public hospital setting.
- To test the hypothesis that demographics, not access or economics, primarily influence CABG outcomes.
Main Methods:
- Retrospective review of 1,556 patient charts undergoing CABG over 10 years at a public hospital.
- Analysis of demographics, comorbidities, surgical parameters, economics, complications, and costs.
- Comparison between insured and uninsured groups using univariate statistics and Kaplan-Meier survival analysis.
Main Results:
- Two-thirds of patients were uninsured, presenting at a younger mean age.
- Ejection fractions and comorbidities were comparable; uninsured had higher tobacco use.
- Uninsured patients demonstrated better overall and late survival than the insured group.
Conclusions:
- Financially challenged individuals access CABG earlier in life with similar disease severity.
- Despite higher tobacco use, uninsured patients achieve equivalent early and superior late survival.
- Public hospitals provide equitable access and quality outcomes for financially challenged patients undergoing CABG.
Objective:
To examine the relation of financial status and demographics to the outcomes of coronary artery bypass surgery (CABG) in the public hospital setting.
Summary Background Data:
Coronary artery bypass surgery is one of the most expensive and frequently performed surgical procedures in the United States. Considerable controversy surrounds the accessibility to quality cardiac care of indigent and minority populations. This study examines the hypothesis that demographics rather than access to care and economics influences outcomes in CABG.
Methods:
A retrospective review of 1,556 charts of patients who underwent CABG at Louisiana State University Health Sciences Center-Shreveport, a public hospital, during a 10-year period was performed. The parameters analyzed included sex, age, race, education, ejection fraction, comorbidities, surgical parameters, economics, complications, and cost of care. Comparisons were made between the insured and uninsured groups. Univariate statistical analysis was used to assess differences between groups. Kaplan-Meier survival curves were also generated.
Results:
Two thirds of the patients were uninsured. The mean age of the uninsured patients was significantly lower than that of the insured patients. Ejection fractions were comparable. Comorbidities were similar, with a greater percentage of tobacco use in the uninsured population. Kaplan-Meier survival curves showed that the uninsured group had better overall survival and that the insured group manifested an increased rate of late death.
Conclusions:
The financially challenged population appears to present for treatment earlier in life with coronary artery disease. Risk factors between the two groups were similar, except that tobacco use appears to be a significant problem in the disadvantaged population. The disease severity in both populations appeared to be similar; however, the uninsured patients had equivalent early survival with better late survival. Access to care in both groups was equal. In the public hospital setting for the disease state described, the financially challenged are afforded access to the current treatment technology with quality results.