CLINICAL STUDY: CARDIAC SURGERY
The effect of race on coronary bypass operative mortality
Charles R. Bridges, MD, ScD, FACC*,
Fred H. Edwards, MD, FACC ,
Eric D. Peterson, MD, MPH, FACC and
Laura P. Coombs, PhD
* Department of Surgery, the University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Department of Surgery, University of Florida Health Sciences Center, Jacksonville, Florida, USA
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Duke Clinical Research Institute, Durham, North Carolina, USA
Manuscript received April 6, 2000;
revised manuscript received June 9, 2000,
accepted July 20, 2000.
Reprint requests and correspondence: Dr. Charles R. Bridges, Department of Surgery, Fourth Floor, Silverstein Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
cbridges{at}mail.med.upenn.edu
OBJECTIVES
The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery.
BACKGROUND
Blacks are less frequently referred for cardiac catheterization and CABG than are whites. Few reports have investigated the relative fate of patients who undergo CABG as a function of race.
METHODS
The Society of Thoracic Surgeons National Database was used to retrospectively review 25,850 black and 555,939 white patients who underwent CABG-alone from 1994 through 1997. A multivariate logistic regression model was developed to determine whether race affected risk-adjusted operative mortality.
RESULTS
Operative mortality was 3.83% for blacks versus 3.14% for whites (unadjusted black/white odds ratio [OR] 1.23 [1.15–1.31]). Blacks were younger, more likely female, hypertensive, diabetic and in heart failure. Nonetheless, the influence of these and other preoperative risk factors on procedural mortality was quite similar in black and white patients. After controlling for all risk factors, race remained a significant independent predictor of mortality in the multivariate logistic model (adjusted black/white OR 1.29 [1.21, 1.38]). Proportionately, these differences were greatest among lower-risk patients. The race-by-gender interaction was significant (p < 0.05). The unadjusted mortality for black men, 3.30% and white men, 2.64% differed significantly (p < 0.05), whereas for women there was no difference (black, 4.49%; white 4.41%).
CONCLUSIONS
Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race.
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Abbreviations and Acronyms
| | BSA | = body surface area | | B/W | = black/white | | CABG | = coronary artery bypass graft | | CAD | = coronary artery disease | | CVA | = cerebrovascular accident | | CVD | = cerebrovascular disease | | COPD | = chronic obstructive pulmonary disease | | IABP | = intraaortic balloon pump | | LVH | = left ventricular hypertrophy | | MI | = myocardial infarction | | NYHA | = New York Heart Association | | OR | = odds ratio | | PVD | = peripheral vascular disease |
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