Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery: A Retrospective Clinical Registry Review in the Drug-eluting Stent Era

Overview

Journal Ann Surg

Specialty General Surgery

Date 2020 Sep 15

PMID 32932322

Citations 22

Authors

Zachary Obinna Enumah

Joseph K Canner

Diane Alejo

Daniel S Warren

Xun Zhou

Gayane Yenokyan

Thomas Matthew

Jennifer S Lawton

Robert S D Higgins

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG.

Summary Background Data: Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated.

Methods: We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission.

Results: The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05-1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21-1.30).

Conclusions: In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be unknown or underappreciated biological mechanisms at play, future research should focus on socioeconomic, cultural, and multilevel factors.

Citing Articles

Female sex is associated with short-term mortality in coronary artery bypass grafting patients: A propensity-matched analysis.

Abbas M, Morland T, Sharma R, Shuhaiber J, Kirchner H, El-Manzalawy Y Heliyon. 2025; 11(2):e41723.

PMID: 39897798 PMC: 11786880. DOI: 10.1016/j.heliyon.2025.e41723.

Female patients exhibit altered vasopressin-induced coronary microvascular contractile response and molecular signaling following cardiac surgery.

Banerjee D, Sabe S, Sodha N, Ehsan A, Cioffi W, Miner T Am J Surg. 2024; 239:116052.

PMID: 39509937 PMC: 11649464. DOI: 10.1016/j.amjsurg.2024.116052.

Racial Disparities in Bypass Graft Outcomes in Women.

Sangwan A Tex Heart Inst J. 2024; 51(1):e248434.

PMID: 39507629 PMC: 11075512. DOI: 10.14503/THIJ-24-8434.

Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG.

Bruno J, Varayath M, Gahl B, Miazza J, Gebhard C, Reuthebuch O Sci Rep. 2024; 14(1):21037.

PMID: 39251616 PMC: 11383960. DOI: 10.1038/s41598-024-71028-8.

Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery.

Scott S, Gouchoe D, Azap L, Henn M, Choi K, Mokadam N Curr Cardiovasc Risk Rep. 2024; 18(7):95-113.

PMID: 39100592 PMC: 11296970. DOI: 10.1007/s12170-024-00739-4.

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