Related Experiment Video
Updated: Aug 25, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Coronary Artery Bypass Surgery Among Medicare Beneficiaries in Health Professional Shortage Areas
James W Stewart1,2,3, Nicholas Kunnath1, Justin B Dimick1
1Department of Surgery, University of Michigan, Ann Arbor, MI.
Insights
Patients in Health Professional Shortage Areas (HPSAs) had similar outcomes after coronary artery bypass grafting (CABG) surgery but faced longer travel times. This highlights a trade-off between access and quality of care in these underserved regions.
Area of Science:
- Healthcare Access and Quality
- Surgical Outcomes Research
- Health Disparities
Background:
- Health Professional Shortage Areas (HPSAs) are designated to identify communities with provider shortages.
- HPSAs are linked to worse health outcomes for general medical conditions.
- Limited data exists on surgical outcomes for high-complexity procedures in HPSAs.
Purpose of the Study:
- To compare postoperative surgical outcomes for high-complexity procedures (CABG) in Medicare beneficiaries residing in HPSAs versus non-HPSAs.
- To assess the impact of HPSA designation on mortality, complications, reoperations, and readmissions.
- To evaluate the travel burden associated with accessing surgical care from HPSAs.
Main Methods:
- Retrospective cohort study of Medicare beneficiaries undergoing CABG (2014-2018).
- Risk-adjusted analysis comparing outcomes (30-day mortality, complications, reoperation, readmission) between HPSA and non-HPSA groups.
- Multivariable logistic regression incorporating patient and hospital characteristics; travel burden calculated by zip code.
Main Results:
- No significant differences in 30-day mortality, complication, reoperation, or readmission rates between HPSA and non-HPSA beneficiaries.
- Beneficiaries in HPSAs experienced significantly longer mean travel times (91.2 vs. 64.0 minutes) and distances (85.0 vs. 59.3 miles).
- A substantial proportion (8.3%) of CABG patients resided in HPSAs.
Conclusions:
- Medicare beneficiaries in HPSAs achieve comparable surgical outcomes for CABG compared to those in non-HPSAs.
- Patients in HPSAs face a significantly greater travel burden to receive this complex surgical care.
- Findings suggest a complex interplay between access to care and quality of outcomes in designated shortage areas.
Objective:
Health professional shortage areas (HPSAs) were created by the Health Resources and Services Administration to identify communities with a shortage of clinical providers. For medical conditions, these designations are associated with worse outcomes. However, far less is known about patients undergoing high-complexity surgical procedures, such as coronary artery bypass grafting (CABG).
Background:
The aim was to compare postoperative surgical outcomes of high-complexity surgery in beneficiaries living in HPSA versus non-HPSA designated areas.
Methods:
This study is a retrospective cohort review of Medicare beneficiaries who underwent CABG between 2014 and 2018. The authors compared risk-adjusted 30-day mortality, complication, reoperation, and readmission rates for beneficiaries living in a designated HPSA versus non-HPSA using a multivariable logistic regression model accounting for patient (eg, age, sex, comorbidities, surgery year) and hospital characteristics (eg, patient-to-nurse ratio, teaching status). Patient travel burden was measured based on the time and distance required to travel from the beneficiary's home zip code to the hospital zip code.
Results:
Of the 370,532 Medicare beneficiaries who underwent CABG, 30,881 (8.3%) lived in a HPSA. Beneficiaries in HPSAs were found to experience comparable 30-day mortality (3.50% vs. 3.65%, P <0.001), complication (32.67% vs. 33.54%, P <0.001), reoperation (1.58% vs. 1.66%, P <0.001), and readmission (14.72% vs. 14.86%, P <0.001) rates. Beneficiaries experienced greater mean travel times (91.2 vs. 64.0 minutes, P <0.001) and mean travel distances (85.0 vs. 59.3 miles, P <0.001).
Conclusions:
Medicare beneficiaries living in designated HPSA experienced comparable surgical outcomes after CABG surgery but a significantly greater travel burden. The greater travel burden experienced by patients living in designated shortage areas to obtain comparable surgical care for complex procedures demonstrates important tradeoffs between access and quality.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Angina IV: Management