The use of an anesthesia information system to identify and trend gender disparities in outpatient medical management of patients with coronary artery disease

Michael M. Vigoda, Luis I. Rodríguez, Eric Wu, Kevin Perry, Robert Duncan, David J. Birnbach, David Lubarsky

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery. METHODS: We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital. RESULTS: Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4% (1346) had CAD. Patients with CAD: Men were more likely to be taking β-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking β-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of β-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for β-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic β-blocker therapy (P < 0.0001 for each medication). CONCLUSION: Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.

Original languageEnglish (US)
Pages (from-to)185-192
Number of pages8
JournalAnesthesia and Analgesia
Volume107
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

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Information Systems
Coronary Artery Disease
Outpatients
Anesthesia
Aspirin
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Management Information Systems
Myocardial Infarction
Therapeutics
Electronic Health Records
Urban Hospitals
Risk Reduction Behavior
Angioplasty
Coronary Artery Bypass
Heart Diseases
Patient Care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The use of an anesthesia information system to identify and trend gender disparities in outpatient medical management of patients with coronary artery disease. / Vigoda, Michael M.; Rodríguez, Luis I.; Wu, Eric; Perry, Kevin; Duncan, Robert; Birnbach, David J.; Lubarsky, David.

In: Anesthesia and Analgesia, Vol. 107, No. 1, 01.01.2008, p. 185-192.

Research output: Contribution to journalArticle

Vigoda, Michael M. ; Rodríguez, Luis I. ; Wu, Eric ; Perry, Kevin ; Duncan, Robert ; Birnbach, David J. ; Lubarsky, David. / The use of an anesthesia information system to identify and trend gender disparities in outpatient medical management of patients with coronary artery disease. In: Anesthesia and Analgesia. 2008 ; Vol. 107, No. 1. pp. 185-192.
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abstract = "BACKGROUND: Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery. METHODS: We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital. RESULTS: Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4{\%} (1346) had CAD. Patients with CAD: Men were more likely to be taking β-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking β-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of β-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for β-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic β-blocker therapy (P < 0.0001 for each medication). CONCLUSION: Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.",
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AU - Rodríguez, Luis I.

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AU - Perry, Kevin

AU - Duncan, Robert

AU - Birnbach, David J.

AU - Lubarsky, David

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N2 - BACKGROUND: Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery. METHODS: We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital. RESULTS: Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4% (1346) had CAD. Patients with CAD: Men were more likely to be taking β-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking β-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of β-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for β-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic β-blocker therapy (P < 0.0001 for each medication). CONCLUSION: Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.

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