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J Cardiothorac Vasc Anesth. 2019 Jul;33(7):1890-1898. doi: 10.1053/j.jvca.2018.10.021. Epub 2018 Oct 22.

An Update on Racial Disparities With 30-Day Outcomes After Coronary Artery Bypass Graft Under the Affordable Care Act.

Author information

1
School of Medicine, University of California, San Diego, San Diego, CA.
2
Department of Anesthesiology, University of California, San Diego, San Diego, CA.
3
Department of Anesthesiology, University of California, San Diego, San Diego, CA; Division of Biomedical Informatics, University of California, San Diego, San Diego, CA. Electronic address: ragabriel@ucsd.edu.

Abstract

OBJECTIVE:

The impact of race on outcomes after coronary artery bypass graft (CABG) has been reported before the enactment of the Patient Protection and Affordable Care Act. However, the impact of race on outcomes post-Affordable Care Act enactment remains unclear. The authors evaluated the association of race with outcomes after enactment of the Affordable Care Act in CABG patients.

DESIGN:

Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016.

SETTING:

Multi-institutional.

PARTICIPANTS:

The authors identified 9,698 CABG patients.

INTERVENTIONS:

CABG.

MEASUREMENTS AND MAIN RESULTS:

Compared with the white population, the black/African American population had higher rates of congestive heart failure, blood transfusion, bleeding disorder, insulin-dependent diabetes mellitus, active smoking, renal dialysis, and hypertension (all p < 0.05). Compared with whites, Asians tended to have a higher prevalence of blood transfusion, American Society of Anesthesiologists class ≥4, diabetes mellitus, and renal dialysis (all p < 0.05). Postoperative red blood cell transfusion (56.5%) and prolonged hospital length of stay ≥12 days (27.7%) were the most prevalent adverse outcomes. Compared with whites, the adjusted odds of postoperative overall morbidity were higher among blacks/African Americans (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.15-1.76, p < 0.001) and Asians (OR: 1.43, 95% CI: 1.06-1.91, p = 0.001). Compared with blacks/African Americans, Asians had higher odds of infection complications (OR: 2.07, 95% CI: 1.10-3.88, p = 0.023).

CONCLUSION:

Differential outcomes were observed for morbidity and mortality outcome measures. The persistence of racial disparities beyond the Affordable Care Act calls for multidisciplinary action.

KEYWORDS:

Affordable Care Act; coronary artery bypass graft; health disparities; surgical outcomes

PMID:
30455143
DOI:
10.1053/j.jvca.2018.10.021

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