Female patients had 1.13 times higher odds and White patients had 1.56 times higher odds of receiving minimally invasive aortic valve replacement versus traditional sternotomy within the same facility (p30.005).
Observational (n=92,611)
Yes
Do sociodemographic factors (sex and race) influence the selection of minimally invasive surgical aortic valve replacement versus traditional sternotomy in adult patients with isolated aortic valve disease?
Non-medical sociodemographic factors, specifically female sex and White race, are associated with a significantly higher likelihood of being selected for minimally invasive aortic valve surgery over traditional sternotomy, highlighting potential healthcare inequities.
Effect estimate: OR 1.13 for females vs males; OR 1.56 for White vs Black patients (within-site analysis) (95% CI Female 1.08-1.18; White 1.39-1.75)
p-value: p=<=0.005
Abstract Background Minimally invasive surgical approaches offers patient benefit, such as expedited recovery, and could reduce hospital cost. This study examines how sociodemographic factors influences surgical approach for aortic valve surgery. Methods We used data from The Society of Thoracic Surgeons’ database to model selection into minimally invasive surgery vs. traditional sternotomy. Pair-matches were created between two identity types: male-vs-female sex and White-vs-Black race. Patients were matched on facility and other covariates. These pair-matches were summarized using generalized linear mixed models (logit-link), regressing surgery type on the relevant identity, with random effects for facility and matched pair. Additionally, a regional analysis summarizing variation in the mortality-risk profiles of patients was conducted. Results From 2015 to 2020, of the patients that met inclusion criteria, 68,956 patients underwent traditional sternotomy and 23,811 underwent minimally invasive surgery. For matched pairs of the examined covariate, the null hypothesis was that each patient would have the same odds of receiving each surgical approach. Our models estimate the odds ratio for receiving the minimally invasive surgery are 1.13 and 1.56 times higher for female and White patients respectively (both p-values <= 0.005). We also identified regional variation across levels of mortality-risk score and race. Conclusions Our study demonstrates a pattern of variation in sorting in minimally invasive surgical aortic valve replacement vs traditional sternotomy via patient sex and race. These findings infer non-medical features guide patient candidacy for surgical approach, even within the same facility.
Burton et al. (Wed,) conducted a observational in Aortic valve disease with stenosis undergoing open aortic valve replacement surgery (n=92,611). Minimally invasive surgical aortic valve replacement (MISAVR) vs. Traditional full sternotomy surgical aortic valve replacement (SAVR) was evaluated on Odds of receiving minimally invasive surgical approach vs traditional sternotomy (OR 1.13 for females vs males; OR 1.56 for White vs Black patients (within-site analysis), 95% CI Female 1.08-1.18; White 1.39-1.75, p=<=0.005). Female patients had 1.13 times higher odds and White patients had 1.56 times higher odds of receiving minimally invasive aortic valve replacement versus traditional sternotomy within the same facility (p30.005).