Persistent Racial Inequities in Postoperative Outcomes After Coronary Artery Bypass Grafting: A National Cohort Study of Over 1.1 Million Patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Artery Disease (n=1159040). Intervention: Black race vs. White race. Primary outcome: In-hospital mortality (aOR 1.22, p=<0.01).

Vinicius Moreira; Rafaella Litvin; Abhin Sapkota; Mariusz Ligocki; Amit Jain; Arjang Khorasani; Farzad Ebrahimi; Nebojša Nick Knežević

doi:10.1053/j.jvca.2026.03.013

March 1, 2026Journal of Cardiothoracic and Vascular AnesthesiaOpen Access

Persistent Racial Inequities in Postoperative Outcomes After Coronary Artery Bypass Grafting: A National Cohort Study of Over 1.1 Million Patients

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Key result

Black patients undergoing coronary artery bypass grafting experienced significantly higher in-hospital mortality compared to White patients (3.2% vs. 2.4%, aOR 1.22), with no temporal improvement.

Why the study?

Does non-White race/ethnicity increase the risk of in-hospital mortality and postoperative complications in adult patients undergoing coronary artery bypass grafting?

Key Points

To evaluate national trends in the association between race and ethnicity and perioperative outcomes after coronary artery bypass grafting (CABG) in the United States between 2016 and 2021.
Retrospective observational cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database.
Analyzed 1,159,040 adult hospitalizations (≥ 18 years) for isolated CABG between 2016 and 2021, using multivariable logistic regression to adjust for demographic and clinical covariates.
Black patients experienced significantly higher in-hospital mortality (3.2% vs. 2.4%, adjusted odds ratio [aOR] 1.22, p < 0.01) and longer hospital stays (mean 11.8 vs. 9.6 days; p < 0.01) compared with White patients.
Rates of major postoperative complications were consistently higher in Black patients than White patients, including cardiac arrest (2.5% vs. 1.8%, aOR 1.23), cardiogenic shock (12.0% vs. 8.9%, aOR 1.21), and sepsis (3.4% vs. 2.3%, aOR 1.17).
Temporal trend analysis revealed no significant improvement in mortality rates across any racial group over the six-year period (Ptrend > 0.30).

Study Design

Type

Cohort (n=1,159,040)

Multicenter

Yes

Structured PICO

Does non-White race/ethnicity increase the risk of in-hospital mortality and postoperative complications in adult patients undergoing coronary artery bypass grafting?

P

Population

1,159,040 adult patients who underwent isolated coronary artery bypass grafting in the United States between 2016 and 2021.

E

Exposure

Coronary artery bypass grafting (CABG) in Black, Hispanic, and other minority racial/ethnic groups

C

Comparator

Coronary artery bypass grafting (CABG) in White patients

O

Outcome

In-hospital mortality and its temporal trend from 2016 to 2021hard clinical

Main Result

Odds Ratio: 1.22

Absolute Event Rate: 3.2% vs 2.4%

p-value: p=<0.01

Significant racial disparities persist in perioperative outcomes following CABG in the United States, with Black patients continuing to experience higher mortality and complication rates despite national equity initiatives.

Limitations

Reliance on administrative data introduces potential for coding inaccuracies and limits clinical granularity
Grouping of individuals of other racial backgrounds into a single 'Other' category
NIS captures only inpatient data, precluding evaluation of post-discharge and long-term outcomes
Lack of data on social determinants of health such as socioeconomic status or education level
Grouping of individuals of other racial backgrounds into a single 'Other' category due to small sample sizes
Captures only inpatient data, precluding evaluation of post-discharge and long-term outcomes
Does not include measures of social determinants of health, such as socioeconomic status or education level

Implication

Persistent CABG mortality disparities in Black patients warrant ongoing clinician attention; leaves open effective equity interventions.

Abstract

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Discussion

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Cite This Study

Moreira et al. (2026) conducted a cohort in Coronary Artery Disease (n=1,159,040). Black race vs. White race was evaluated on In-hospital mortality (aOR 1.22, p=<0.01). Black patients undergoing coronary artery bypass grafting experienced significantly higher in-hospital mortality compared to White patients (3.2% vs. 2.4%, aOR 1.22), with no temporal improvement.

synapsesocial.com/papers/69b3aad702a1e69014ccb8db https://doi.org/10.1053/j.jvca.2026.03.013

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Persistent Racial Inequities in Postoperative Outcomes After Coronary Artery Bypass Grafting: A National Cohort Study of Over 1.1 Million Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Persistent Racial Inequities in Postoperative Outcomes After Coronary Artery Bypass Grafting: A National Cohort Study of Over 1.1 Million Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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