Related Experiment Video
Updated: Aug 2, 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 grafting at safety-net versus non-safety-net hospitals
William C Frankel1, Christopher B Sylvester1,2,3, Sainath Asokan1
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Insights
Safety-net hospitals (SNHs) provide essential care. After matching, coronary artery bypass grafting (CABG) outcomes were comparable at SNHs and non-SNHs, indicating SNHs can provide quality care.
Area of Science:
- Health Services Research
- Cardiovascular Surgery
- Health Equity
Background:
- Safety-net hospitals (SNHs) are crucial for underserved populations.
- Coronary artery bypass grafting (CABG) is a major surgical procedure.
- Understanding outcomes at SNHs is vital for health equity.
Purpose of the Study:
- To compare early outcomes of coronary artery bypass grafting (CABG) between safety-net hospitals (SNHs) and non-SNHs.
- To determine if observed outcome disparities persist after accounting for patient and hospital characteristics.
- To evaluate the impact of hospital type on the quality of care for CABG patients.
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2018) for isolated CABG cases.
- Defined SNHs as hospitals in the top quartile for uninsured/Medicaid patient admissions.
- Employed propensity-score matching to compare outcomes between SNHs and non-SNHs.
Main Results:
- Initially, SNHs had higher comorbidity burden, more urgent surgeries, and worse observed outcomes (mortality, morbidity, length of stay, cost, readmissions).
- After propensity-score matching, significant differences in mortality, morbidity, and readmissions were eliminated.
- Length of stay and cost remained higher at SNHs post-matching.
Conclusions:
- Early outcomes after coronary artery bypass grafting (CABG) are comparable between safety-net hospitals (SNHs) and non-SNHs when accounting for patient factors.
- SNHs can provide high-quality CABG care, challenging initial assumptions of inferior outcomes.
- Targeted interventions, such as improved discharge resources, may further reduce length of stay and cost, enhancing the value of CABG at SNHs.
Objectives:
Safety-net hospitals (SNHs) provide essential services to predominantly underserved patients regardless of their ability to pay. We hypothesized that patients who underwent coronary artery bypass grafting (CABG) would have inferior observed outcomes at SNHs compared with non-SNHs but that matched cohorts would have comparable outcomes.
Methods:
We queried the Nationwide Readmissions Database for patients who underwent isolated CABG from 2016 to 2018. We ranked hospitals by the percentage of all admissions in which the patient was uninsured or insured with Medicaid; hospitals in the top quartile were designated as SNHs. We used propensity-score matching to mitigate the effect of confounding factors and compare outcomes between SNHs and non-SNHs.
Results:
A total of 525,179 patients underwent CABG, including 96,133 (18.3%) at SNHs, who had a greater burden of baseline comorbidities (median Elixhauser score 8 vs 7; P = .04) and more frequently required urgent surgery (57.1% vs 52.8%; P < .001). Observed in-hospital mortality (2.1% vs 1.8%; P = .004) and major morbidity, length of stay (9 vs 8 days; P < .001), cost ($46,999 vs $38,417; P < .001), and readmission rate at 30 (12.4% vs 11.3%) and 90 days (19.0% vs 17.7%) were greater at SNHs (both P < .001). After matching, none of these differences persisted except length of stay (9 vs 8 days) and cost ($46,977 vs $39,343) (both P < .001).
Conclusions:
After matching, early outcomes after CABG were comparable at SNHs and non-SNHs. Improved discharge resources could reduce length of stay and curtail cost, improving the value of CABG at SNHs.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management