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Circ Cardiovasc Qual Outcomes. 2017 Jun;10(6). pii: e003327. doi: 10.1161/CIRCOUTCOMES.116.003327.

Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

Author information

1
From the National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (Z.Z., H.Z., X.Y., C.R., Y.Z., S.H.), and Department of Cardiovascular Surgery (Z.Z., H.Z., X.Y., C.R., S.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Health Care Policy, Harvard Medical School and the Department of Biostatistics, Boston, MA (S.-L.N.); Harvard T.H. Chan School of Public Health, Boston, MA (Y.W., S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (Y.W., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
2
From the National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (Z.Z., H.Z., X.Y., C.R., Y.Z., S.H.), and Department of Cardiovascular Surgery (Z.Z., H.Z., X.Y., C.R., S.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Health Care Policy, Harvard Medical School and the Department of Biostatistics, Boston, MA (S.-L.N.); Harvard T.H. Chan School of Public Health, Boston, MA (Y.W., S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (Y.W., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). zhengzhe@fuwai.com shengshouhu@yahoo.com.

Abstract

BACKGROUND:

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals.

METHODS AND RESULTS:

Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P=0.059; and 3.12% versus 2.20%, P=0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P<0.001). This difference did not change significantly over time.

CONCLUSIONS:

In 2011 to 2013, there was no significant difference in in-hospital mortality among patients who underwent an isolated CABG surgery in large teaching and urban hospitals in China and the United States. The longer length of stay in China may represent an opportunity for improvement.

KEYWORDS:

comorbidity; coronary artery bypass grafting; coronary artery disease; hospital mortality; length of stay

PMID:
28611187
PMCID:
PMC5482563
DOI:
10.1161/CIRCOUTCOMES.116.003327
[Indexed for MEDLINE]
Free PMC Article

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