Relation of race, ethnicity and cardiac surgeons to operative mortality rates in primary coronary artery bypass grafting in California

Luis R. Castellanos, Zhongmin Li, Khung Keong Yeo, J Nilas Young, John Z. Ayanian, Ezra A Amsterdam

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11 Citations (Scopus)

Abstract

The aim of this study was to evaluate whether African American, Hispanic, and Asian patients in California were more likely to undergo coronary artery bypass grafting (CABG) by cardiac surgeons with higher risk-adjusted mortality rates (RAMRs). Clinical data from the California CABG Outcomes Reporting Program were analyzed for all patients who underwent isolated CABG from 2003 to 2006 by surgeons who performed <10 operations. Surgeons were divided into quintiles on the basis of their RAMRs, with the top-performing surgeons in the first quintile and the lowest performing surgeons in the fifth quintile. There were 72,845 isolated CABG procedures performed by 303 surgeons, including 49,886 in white, 9,380 in Hispanic, 6,867 in Asian, and 2,750 in African American patients. African American and Asian patients underwent CABG by surgeons with higher mean RAMRs (2.90% and 2.99%, respectively) compared with the state average of 2.65% (p <0.001). Compared to white patients, Asian and Hispanic patients were more likely to be treated by surgeons in the lowest quintile (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.11 to 1.3, and OR 1.38, 95% CI 1.30 to 1.48, respectively). African Americans and Hispanics were less likely to be operated on by surgeons in the top quintile compared to white patients (OR 0.80, 95% CI 0.71 to 0.90, and OR 0.81, 95% CI 0.76 to 0.87, respectively). Hispanics were less likely to be treated by surgeons in the top quintile than by surgeons in the lowest quintile (OR 0.65, 95% CI 0.60 to 0.75). In conclusion, racial and ethnic minority patients who undergo isolated CABG in California may be more likely to be operated on by cardiac surgeons with higher RAMRs.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalAmerican Journal of Cardiology
Volume107
Issue number1
DOIs
StatePublished - Jan 2011

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Race Relations
Coronary Artery Bypass
Mortality
Hispanic Americans
African Americans
Odds Ratio
Confidence Intervals
Surgeons

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of race, ethnicity and cardiac surgeons to operative mortality rates in primary coronary artery bypass grafting in California. / Castellanos, Luis R.; Li, Zhongmin; Yeo, Khung Keong; Young, J Nilas; Ayanian, John Z.; Amsterdam, Ezra A.

In: American Journal of Cardiology, Vol. 107, No. 1, 01.2011, p. 1-5.

Research output: Contribution to journalArticle

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abstract = "The aim of this study was to evaluate whether African American, Hispanic, and Asian patients in California were more likely to undergo coronary artery bypass grafting (CABG) by cardiac surgeons with higher risk-adjusted mortality rates (RAMRs). Clinical data from the California CABG Outcomes Reporting Program were analyzed for all patients who underwent isolated CABG from 2003 to 2006 by surgeons who performed <10 operations. Surgeons were divided into quintiles on the basis of their RAMRs, with the top-performing surgeons in the first quintile and the lowest performing surgeons in the fifth quintile. There were 72,845 isolated CABG procedures performed by 303 surgeons, including 49,886 in white, 9,380 in Hispanic, 6,867 in Asian, and 2,750 in African American patients. African American and Asian patients underwent CABG by surgeons with higher mean RAMRs (2.90{\%} and 2.99{\%}, respectively) compared with the state average of 2.65{\%} (p <0.001). Compared to white patients, Asian and Hispanic patients were more likely to be treated by surgeons in the lowest quintile (odds ratio [OR] 1.2, 95{\%} confidence interval [CI] 1.11 to 1.3, and OR 1.38, 95{\%} CI 1.30 to 1.48, respectively). African Americans and Hispanics were less likely to be operated on by surgeons in the top quintile compared to white patients (OR 0.80, 95{\%} CI 0.71 to 0.90, and OR 0.81, 95{\%} CI 0.76 to 0.87, respectively). Hispanics were less likely to be treated by surgeons in the top quintile than by surgeons in the lowest quintile (OR 0.65, 95{\%} CI 0.60 to 0.75). In conclusion, racial and ethnic minority patients who undergo isolated CABG in California may be more likely to be operated on by cardiac surgeons with higher RAMRs.",
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