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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Racial Disparity: The Adult Congenital Heart Disease Surgery Perspective
Castigliano M Bhamidipati1, Ibett Colina Garcia2, Bohye Kim3
1Cardiac Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L353, Portland, OR, 97239, USA. bhamidip@ohsu.edu.
Insights
Race impacts outcomes in adult congenital heart disease (ACHD) surgery. Black patients had similar complication rates but lower discharge home rates, while non-white, non-black patients had decreased major complication odds but increased mortality.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Health Equity
Background:
- The influence of race and ethnicity on medical outcomes is recognized, yet its specific impact on adult congenital heart disease (ACHD) surgery outcomes remains unclear.
- Existing research highlights disparities in healthcare access and outcomes across racial groups, necessitating investigation within specialized surgical fields like ACHD.
Purpose of the Study:
- To investigate the association between race and clinical outcomes, including complications, mortality, and discharge disposition, following ACHD surgery.
- To identify potential racial disparities in the care and outcomes of patients undergoing ACHD operations.
Main Methods:
- Utilized discharge records from an all-payer voluntary database in the United States (2005-2014) for patients undergoing ACHD surgery.
- Employed hierarchical case-mix regression models and sensitivity analyses to compare outcomes (complications, in-hospital mortality, discharge disposition) across racial groups: white (WP), black (BP), and non-white non-black (NWNB).
Main Results:
- Black patients were younger at surgery and more likely to have comorbidities and post-operative cardiac complications compared to white patients.
- Black patients experienced similar overall complication rates but lower rates of discharge home, while non-white, non-black patients had significantly decreased odds of major complications but increased in-hospital mortality compared to white patients.
- Adjusted analyses revealed specific outcome differences: Black patients had similar odds of any complication but were less likely to be discharged home. Non-white, non-black patients had decreased odds of major complications but increased odds of in-hospital mortality.
Conclusions:
- Race is significantly associated with clinical outcomes in patients undergoing adult congenital heart disease surgery.
- Disparities exist in complication rates, mortality, and discharge disposition among different racial groups undergoing ACHD surgery.
- Further research is crucial to understand the underlying mechanisms driving these racial disparities to improve care for the ACHD population.
Abstract:
The influence of race and ethnicity on clinical outcomes in medicine are widely acknowledged. However, the effect of race on adult congenital heart disease (ACHD) surgery is not known. We sought to evaluate the possible association between race and outcomes following ACHD operations. Discharge records for patients who underwent ACHD surgery between 2005 and 2014, were isolated from an all-payer voluntary database in the United States. Hierarchical case-mix regression models and sensitivity analyses examined any complication, in-hospital mortality, and discharge disposition (home/non-home) by race (white-WP, black-BP, non-white non-black-NWNB). Of the 174,370 patients (WP: 80.8%, BP: 5.8%, NWNB: 13.4%), black patients were youngest to undergo surgery (WP: 57.9 ± 15.8 years, BP: 50.2 ± 16.1 years, NWNB: 51.6 ± 16.9 years, P < 0.0001), the most likely to have a comorbidity (WP: 70.3%, BP: 74.3%, NWNB: 68.6%, P < 0.0001), and most likely to have had a post-operative cardiac complication (WP: 9.4%, BP: 15.3%, NWNB: 10.9%, P < 0.0001). BP had similar odds of having any complication (AOR = 0.99, 95%CI = 0.94-1.04), while NWNB had significantly decreased odds of a major complication (AOR = 0.90, 95%CI = 0.87-0.93). BP had equivalent in-hospital mortality compared to WP (AOR = 1.03, 95%CI = 0.91-1.18), while NWNB had significantly increased odds of in-hospital mortality (AOR = 1.29, 95%CI = 1.18-1.41). Among survivors, BP were less likely to discharge home (AOR = 0.88, 95%CI = 0.82-0.94), and NWNB were more likely to discharge home than WP (AOR = 1.26, 95%CI = 1.19-1.33). Race and clinical outcomes are associated among patients undergoing surgery for ACHD. Understanding why and how these factors are impactful will help improve care for this complex population.
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