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Risk of aortocoronary bypass surgery in a low-volume inner city hospital
A K Mandal1, V S Kaushik, S S Oparah
1Department of Surgery and Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA.
Insights
This study demonstrates that low-volume centers can achieve comparable outcomes for coronary artery bypass grafting in socioeconomically disadvantaged populations. Results show similar mortality and complication rates compared to high-volume centers.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Health Disparities
Background:
- Coronary heart disease (CHD) mortality is higher in low socioeconomic groups.
- Higher mortality rates have been associated with lower-volume open-heart surgery centers.
- Existing data suggest disparities in surgical outcomes based on socioeconomic status and surgical volume.
Purpose of the Study:
- To evaluate the outcomes of coronary artery surgery in a low socioeconomic, predominantly minority population.
- To determine if a low-volume surgical center can achieve results comparable to high-volume centers for this patient group.
- To challenge the assumption that socioeconomic status and surgical volume significantly impact myocardial revascularization outcomes.
Main Methods:
- Retrospective analysis of 76 patients undergoing coronary artery surgery over 8 years.
- Patients were from a low socioeconomic, inner-city minority population (84% Black).
- The surgical center performed fewer than 20 open-heart surgeries annually.
Main Results:
- Overall mortality rate was 5.3%.
- Infection rate was 1.3%.
- Perioperative infarction rate was 7.9%.
- These outcomes were not significantly different from reported results at high-volume centers for similar patients.
Conclusions:
- Comparable outcomes for myocardial revascularization are achievable in low-volume centers.
- Socioeconomically disadvantaged and minority populations can receive effective coronary artery surgery.
- Evidence suggests that quality of care may be independent of surgical volume and patient socioeconomic status in this context.
Abstract:
Incidence of coronary heart disease deaths has been reported to be higher in low socioeconomic groups compared to affluent subjects. In addition, a higher mortality rate has been reported at centers doing fewer open heart surgeries. This article presents evidence in variance with these convictions. We report a single team's experience with coronary artery surgery on 76 low socioeconomic, predominantly black patients (84%) over a period of 8 years. The volume of open heart surgery per year was less than 20. The overall mortality rate of 5.3%, infection rate of 1.3%, and perioperative infarction rate of 7.9% are not significantly different from the reported experience of high-volume surgical centers on similar patients during the same period. Thus, it is possible to obtain comparable results of myocardial revascularization surgery in low-volume, socioeconomically disadvantaged, inner city minority populations.