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Racial Differences in Outcomes After Perioperative Myocardial Infarction: A Multicenter Analysis of Noncardiac
Emuejevoke Chuba1, Sibelle Aurelie Yemele Kitio2, Ata Murat Kaynar3
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA. e.chuba@ufl.edu.
Background:
Perioperative myocardial infarction (PMI) is a common cardiovascular complication following noncardiac surgery and is associated with significant morbidity and mortality. However, data on racial disparities in outcomes remain limited. This study evaluates racial differences and complications among patients who experience PMI following moderate- to high-risk noncardiac surgery.
Methods:
We analyzed the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent moderate- to high-risk noncardiac surgeries between 2010 and 2020. Demographic and clinical variables were compared across racial groups. Multivariable logistic regression was used to assess the impact of race on 30-day mortality and postoperative complications after adjusting for preoperative comorbidities and perioperative risk factors.
Results:
Among 23,273 patients with PMI, the overall 30-day mortality rate was approximately 20% and did not differ significantly by race (P = .33). After adjustment for other covariables, Black race was independently associated with higher odds of acute renal failure (OR: 1.511; CI: 1.277-1.789; P < .0001), prolonged postoperative mechanical ventilation for > 48 h (OR: 1.312; CI: 1.169-1.471; P < .0001), pulmonary embolism (OR: 1.659; CI: 1.322-2.081; P < .0001), cardiac arrest requiring cardiopulmonary resuscitation (OR: 1.428; CI: 1.252-1.629; P < .0001), and return to the operating room (OR: 1.228; 95% CI: 1.097-1.374; P = .0017). Black patients also experienced longer hospital stays (IRR: 1.087; 95% CI: 1.027-1.151; P < .0001).
Conclusion:
While 30-day mortality following PMI did not differ by race, Black patients experienced increased postoperative morbidities. These findings underscore the need for targeted perioperative interventions to mitigate racial disparities in postoperative outcomes.
Insights
While 30-day mortality after perioperative myocardial infarction (PMI) is similar across races, Black patients face higher risks for complications like acute renal failure and prolonged ventilation. Targeted interventions are needed to address these disparities in surgical outcomes.
Area of Science:
- Cardiology
- Surgical Outcomes
- Health Disparities
Background:
- Perioperative myocardial infarction (PMI) is a significant complication after noncardiac surgery, linked to high morbidity and mortality.
- Existing data on racial disparities in PMI outcomes are limited.
- This study investigates racial differences in complications following PMI in moderate- to high-risk noncardiac surgery patients.
Purpose of the Study:
- To evaluate racial differences in outcomes among patients experiencing PMI after noncardiac surgery.
- To identify specific postoperative complications that may disproportionately affect different racial groups.
- To inform targeted interventions aimed at reducing racial disparities in surgical care.
Main Methods:
- Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2010-2020).
- Inclusion of patients undergoing moderate- to high-risk noncardiac surgeries who experienced PMI.
- Multivariable logistic regression to assess the impact of race on 30-day mortality and complications, adjusting for covariates.
Main Results:
- Among 23,273 patients with PMI, 30-day mortality was ~20% and did not significantly vary by race (P = .33).
- Black race was independently associated with increased odds of acute renal failure, prolonged mechanical ventilation (>48h), pulmonary embolism, cardiac arrest requiring CPR, and return to the OR.
- Black patients experienced significantly longer hospital stays compared to other racial groups.
Conclusions:
- Despite similar 30-day mortality rates post-PMI across racial groups, Black patients exhibit higher rates of specific postoperative morbidities.
- These findings highlight critical racial disparities in the severity and type of complications following PMI.
- There is a clear need for targeted perioperative strategies to mitigate these adverse outcomes and reduce racial inequities in surgical patient care.
