Racial disparity in cardiac surgery risk and outcome: Report from a statewide quality initiative.Ann Thorac Surg. 2020 Jan 18 [Online ahead of print]AT
Racial disparities persist in healthcare. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland.
Patients were identified using a statewide database. Demographics, comorbidities, and predicted risk of mortality were compared between races. Crude mortality and incidence of complications were compared between groups, as were risk-adjusted odds for mortality and major morbidity or mortality.
The study included 23,094 patients. The majority of patients were white (75.8%), followed by African American (16.3%), Asian (3.8%), and other races (4.1%). African Americans had higher preoperative risk for mortality based on the Society of Thoracic Surgeons predictive models compared to white patients (3.0% versus 2.3%, P<0.001). African Americans also had higher prevalence of diabetes mellitus, hypertension, peripheral vascular disease, and cerebral vascular disease than white patients. After adjustment for preoperative risk, there was no difference in 30-day mortality between African Americans (OR=1.26, 95% CI=0.99 to 1.59), Asians (OR=1.22, 95% CI=0.75 to 1.97), and other races (OR=1.18, 95% CI=0.74 to 1.89) compared to whites. African Americans had lower risk-adjusted odds of major morbidity or mortality compared to whites (OR=0.83, 95% CI=0.75 to 0.93).
African American cardiac surgery patients have the highest preoperative risk in Maryland. Patients appeared to receive excellent cardiac surgery care, regardless of race, as risk adjusted mortality did not differ between groups and African American patients had lower risk adjusted odds of major morbidity or mortality than white patients. Future interventions in Maryland should be aimed at reducing preoperative risk disparity in cardiac surgery patients.