Persistent Racial Inequities in Postoperative Outcomes After Coronary Artery Bypass Grafting: A National Cohort Study of More Than 1.1 Million Patients
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Published on: March 27, 2018
Vinicius Moreira1, Rafaella Litvin2, Abhin Sapkota3
1Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation. Cleveland, OH.
Objectives:
To evaluate trends in the association between race and ethnicity and perioperative outcomes after CABG in the United States and assess whether disparities have changed over the timeframe analyzed.
Design:
Retrospective, observational cohort study.
Setting:
National, multi-institutional analysis using the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database.
Participants:
Adult patients (≥ 18 years) who underwent isolated CABG between 2016 and 2021.
Interventions:
No interventions were performed. Patient and hospital data were analyzed to compare postoperative outcomes across racial and ethnic groups.
Measurements And Main Results:
The primary outcome was in-hospital mortality; secondary outcomes included length of stay (LOS), cardiac arrest, cardiogenic shock, and sepsis. Multivariable logistic regression was used to adjust for demographic and clinical covariates. Among 1,159,040 CABG hospitalizations, Black patients accounted for 6.7% of cases, presented at younger ages (mean 63 years), and had higher comorbidity burdens (Charlson Comorbidity Index 3.25 vs. 2.52 in White patients; p < 0.01). Black race was associated with higher in-hospital mortality (3.2% vs. 2.4%, adjusted odds ratio [aOR] 1.22, p < 0.01), longer LOS (11.8 vs. 9.6 days; p < 0.01), and greater rates of cardiogenic shock and sepsis. No significant temporal improvement in mortality trends was observed for any racial group ( Ptrend > 0.30).
Conclusions:
Significant racial disparities persist in perioperative outcomes following CABG in the United States. Black patients continue to experience higher mortality, longer hospitalizations, and increased complications despite national initiatives to reduce inequities.
