Abstract 6227: Ethnic Minority Patients Are More Likely to Undergo Coronary Artery Bypass Operations by Surgeons with Increased Operative Mortality Rates
Background: It has been suggested that coronary artery bypass graft surgery (CABG) is performed in ethnic minority patients (pts) by surgeons with increased operative mortality rates. Therefore, we sought to evaluate whether Hispanics, Asians, Blacks and Native Americans in California were more likely to be operated by cardiac surgeons with either higher or lower risk-adjusted mortality rates (RAMR).
Methods: We analyzed clinical data from the California CABG Outcomes Reporting Program on all pts receiving isolated CABG during 2003–2004 by surgeons who performed ≥10 operations during this period. Surgeons were divided into four operative mortality performance groups based on their RAMR: top decile, top quartile, lowest quartile and lowest decile. The proportion of ethnic minorities in each performance group was analyzed.
Results: A total of 40,233 isolated CABG were performed by 276 surgeons. The cohort included 28,175 Whites (70%), 4,879 Hispanics (12%), 3,550 Asians (8.8%), 1,480 Blacks (3.7%), and 170 Native Americans (0.4%). The overall surgeons’ RAMR for these ethnic groups were not significantly different (p>0.05) compared to the state average of 3.08%. However, in the top quartile group, Black and Hispanic pts were almost one third less likely to be operated upon by surgeons when compared to White pts (OR 0.67, 95% CI 0.58–0.78 and OR 0.80, 95% CI 0.74–0.87, respectively). Compared with Whites, Hispanics, Asians and Native Americans were more likely to be treated by surgeons in the lowest decile group (OR 1.92, 95% CI 1.70–2.17; OR 1.31, 95% CI 1.12–1.54; and OR 1.96, 95% CI 1.11–3.47, respectively). Hispanics were almost two times less likely to be treated by surgeons in the top decile group than by surgeons in the lowest decile group (OR 0.53, 95% CI 0.44–0.64). By contrast, White pts were almost two times more likely to receive CABG from surgeons in the top decile group than by surgeons in the lowest decile group (OR 1.75, 95% CI 1.52–2.02).
Conclusions: Ethnic minority pts undergoing isolated CABG surgery in California may be more likely to be operated on by cardiac surgeons with higher RAMR and less likely to be operated on by cardiac surgeons with lower RAMR. Further studies are needed in order to identify factors associated with the observed disparities.