Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

To examine explanations of differences in utilization rates of a newly reintroduced technique - off-pump coronary artery bypass grafting (CABG) - between racial minorities and Whites.

The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of off-pump versus on-pump surgery.

Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent off-pump CABG (P <0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks treated by surgeons with low volume off-pump procedures were 1.9 times (P <0.01) more likely to have off-pump surgery compared with Whites treated by the same surgeons. There were no significant differences between Blacks and Whites treated by high volume surgeons.

These findings suggest that surgeons who are inexperienced with the off-pump techniques are more likely to perform this surgery on Black patients. Further research should examine potential explanations and the agenda addressing racial disparities should be expanded to address issues of treatment decisions.