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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

Abstract

BACKGROUND

Racial disparities persist in healthcare. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

University of Maryland School of MedicineDepartment of Anesthesiology Baltimore, MD 21201. Electronic address: mmazzeffi@som.umaryland.edu.University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD 21201.Johns Hopkins University School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD 21287.Maryland Cardiac Surgery Quality Initiative, Inc. Baltimore, Maryland 21287.University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD 21201.University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD 21201.Johns Hopkins University School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD 21287.Johns Hopkins University School of Medicine, Department of Medicine, Division of Cardiology, Baltimore, MD 21287.University of Maryland, St. Joseph Medical Center, Department of Cardiothoracic Surgery, Towson, MD 21204.Johns Hopkins University School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD 21287.University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD 21201; Washington Adventist Hospital, Department of Cardiothoracic Surgery, Takoma Park, Maryland 20912.Johns Hopkins University School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD 21287.University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD 21201.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31962111

Citation

Mazzeffi, Michael, et al. "Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative." The Annals of Thoracic Surgery, 2020.
Mazzeffi M, Holmes SD, Alejo D, et al. Racial disparity in cardiac surgery risk and outcome: Report from a statewide quality initiative. Ann Thorac Surg. 2020.
Mazzeffi, M., Holmes, S. D., Alejo, D., Fonner, C. E., Ghorieshi, M., Pasrija, C., Schena, S., Metkus, T., Salenger, R., Whitman, G., Ad, N., Higgins, R. S. D., & Taylor, B. (2020). Racial disparity in cardiac surgery risk and outcome: Report from a statewide quality initiative. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2019.11.043
Mazzeffi M, et al. Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative. Ann Thorac Surg. 2020 Jan 18; PubMed PMID: 31962111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparity in cardiac surgery risk and outcome: Report from a statewide quality initiative. AU - Mazzeffi,Michael, AU - Holmes,Sari D, AU - Alejo,Diane, AU - Fonner,Clifford E, AU - Ghorieshi,Mehrdad, AU - Pasrija,Chetan, AU - Schena,Stefano, AU - Metkus,Thomas, AU - Salenger,Rawn, AU - Whitman,Glenn, AU - Ad,Niv, AU - Higgins,Robert S D, AU - Taylor,Bradley, AU - ,, Y1 - 2020/01/18/ PY - 2019/06/08/received PY - 2019/10/02/revised PY - 2019/11/15/accepted PY - 2020/1/22/entrez PY - 2020/1/22/pubmed PY - 2020/1/22/medline JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. N2 - BACKGROUND: Racial disparities persist in healthcare. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/31962111/Racial_disparity_in_cardiac_surgery_risk_and_outcome:_Report_from_a_statewide_quality_initiative L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(20)30032-1 DB - PRIME DP - Unbound Medicine ER -
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