SHARE @ Advocate Health - Midwest - Scientific Day: Racial Disparities After Coronary Artery Bypass Graft in the United States From 2016 to 2021, a Large Database Analysis
 

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background/Significance:

In recent years, there has been increased interest in identifying racial disparities in perioperative outcomes. It is documented that Black and Hispanic patients experience higher morbidity and mortality rates following coronary artery bypass graft (CABG) surgery compared to other races. As studies have highlighted this issue, we anticipated that morbidity and mortality rates would decline with improvements in racially sensitive healthcare. This study presents a temporal analysis of mortality and post-operative outcomes, stratified by race, from 2016 to 2021.

Purpose:

This study examines trends in mortality and post-operative outcomes across all racial groups represented in the National Inpatient Sample (NIS) database.

Methods:

We extracted data from the NIS database for patients undergoing CABG in the United States from 2016 to 2021. The primary outcome assessed was the trend in in-hospital mortality. The secondary outcomes were length of stay, cardiac arrest, cardiogenic shock, and sepsis. Subgroup analysis was performed for White, Black and Hispanic patients for all the listed outcomes. Additionally, we drew a cumulative analysis for all patients included in the study to assess variability in outcomes and demographics between races. Multivariate logistic regression was performed to assess statistical significance and adjust for demographic variability.

Results:

During the analyzed period, 1,159,040 patients underwent CABG in the US. Black patients had the lowest proportion of CABG admissions at 0.30%, compared to 0.76% for White patients, 0.44% for Hispanic patients, and 0.73% for other races (p < 0.01). Black patients also had the highest proportion of CABG procedures at younger ages: 4.2% between 18-45 years and 49.6% between 45-65 years (p < 0.01). Black patients had the highest burden of comorbidities, with a Comorbidity Index of 3.25 compared to 2.52 for White patients (p < 0.01). Cumulatively, Black patients had 22% increased odds of in-hospital mortality compared to White patients, a 23% increase in odds of cardiac arrest, a 21% increase in odds of cardiogenic shock, and a 17% increase in odds of sepsis (all p < 0.01). In-hospital mortality trends remained consistent across all races, with Black patients persistently experiencing higher mortality rates.

Conclusion:

Despite expectations for decreased mortality as healthcare systems improve care, we observed a stable mortality trend across all races, with disproportionately high rates for Black patients.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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May 21st, 4:27 PM May 21st, 4:47 PM

Racial Disparities After Coronary Artery Bypass Graft in the United States From 2016 to 2021, a Large Database Analysis

Background/Significance:

In recent years, there has been increased interest in identifying racial disparities in perioperative outcomes. It is documented that Black and Hispanic patients experience higher morbidity and mortality rates following coronary artery bypass graft (CABG) surgery compared to other races. As studies have highlighted this issue, we anticipated that morbidity and mortality rates would decline with improvements in racially sensitive healthcare. This study presents a temporal analysis of mortality and post-operative outcomes, stratified by race, from 2016 to 2021.

Purpose:

This study examines trends in mortality and post-operative outcomes across all racial groups represented in the National Inpatient Sample (NIS) database.

Methods:

We extracted data from the NIS database for patients undergoing CABG in the United States from 2016 to 2021. The primary outcome assessed was the trend in in-hospital mortality. The secondary outcomes were length of stay, cardiac arrest, cardiogenic shock, and sepsis. Subgroup analysis was performed for White, Black and Hispanic patients for all the listed outcomes. Additionally, we drew a cumulative analysis for all patients included in the study to assess variability in outcomes and demographics between races. Multivariate logistic regression was performed to assess statistical significance and adjust for demographic variability.

Results:

During the analyzed period, 1,159,040 patients underwent CABG in the US. Black patients had the lowest proportion of CABG admissions at 0.30%, compared to 0.76% for White patients, 0.44% for Hispanic patients, and 0.73% for other races (p < 0.01). Black patients also had the highest proportion of CABG procedures at younger ages: 4.2% between 18-45 years and 49.6% between 45-65 years (p < 0.01). Black patients had the highest burden of comorbidities, with a Comorbidity Index of 3.25 compared to 2.52 for White patients (p < 0.01). Cumulatively, Black patients had 22% increased odds of in-hospital mortality compared to White patients, a 23% increase in odds of cardiac arrest, a 21% increase in odds of cardiogenic shock, and a 17% increase in odds of sepsis (all p < 0.01). In-hospital mortality trends remained consistent across all races, with Black patients persistently experiencing higher mortality rates.

Conclusion:

Despite expectations for decreased mortality as healthcare systems improve care, we observed a stable mortality trend across all races, with disproportionately high rates for Black patients.

 

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