Key result
Indigenous Australian status is linked to ~46% higher late mortality following cardiac surgery.
Why the study?
Indigenous Australians undergoing cardiac surgery have distinct baseline characteristics and mortality outcomes that require detailed description.
Does Indigenous Australian status affect operative and late mortality in patients undergoing cardiac surgery?
Cohort (n=2,635)
No
Does Indigenous Australian status affect operative and late mortality in patients undergoing cardiac surgery?
Hazard Ratio: 1.67 (95% CI 0.74–3.75)
Absolute Event Rate: 2.5% vs 1.3%
Indigenous Australians undergoing cardiac surgery present at a significantly younger age and experience higher adjusted operative and late mortality compared to non-Indigenous patients.
Suggests higher late mortality risk for Indigenous Australians after cardiac surgery; leaves open whether targeted interventions can reduce disparities.
OBJECTIVE: To describe baseline characteristics, operative events and late mortality among Indigenous Australians undergoing cardiac surgery. DESIGN, SETTING AND PARTICIPANTS: Prospective study of consecutive patients undergoing cardiac surgery at Flinders Medical Centre in Adelaide between January 2000 and December 2005. MAIN OUTCOME MEASURES: Operative (30-day) mortality and late mortality after cardiac surgery. RESULTS: Of 2635 patients undergoing cardiac surgery, 283 (10.7%) were Indigenous. Indigenous patients were substantially younger than non-Indigenous patients (mean, 47 [SD, 14] years v 65 [SD, 12] years; P = 0.001) and were more likely to have diabetes (39.6% v 27.3%; P = 0.001), renal dysfunction (3.2% v 1.2%; P = 0.009), and valvular surgery (53.0% v 23.1%; P < 0.001). There was a non-significant trend toward excess operative mortality in Indigenous patients (Indigenous 2.5% v non-Indigenous 1.3%; hazard ratio [HR], 1.67 [95% CI, 0.74-3.75]). But in the under-55-years age cohort, the difference between the two groups was highly significant (Indigenous 3.3% v non-Indigenous 0.4%; HR, 7.99 [95% CI, 1.66-38.50]), even after adjustment for euroSCORE (the European System for Cardiac Operative Risk Evaluation). Survival at 1 and 5 years was 94.0% and 80.6%, respectively, for Indigenous patients compared with 96.7% and 87.7%, respectively, for non-Indigenous patients. There was an excess in euroSCORE-adjusted mortality in the Indigenous cohort overall (HR, 1.46 [95% CI, 1.03-2.07]) that strengthened when restricted to the under-55-years cohort (HR, 6.9 [95% CI, 1.42-33.5]). CONCLUSION: Indigenous Australians present for cardiac surgery nearly 20 years earlier than non-Indigenous Australians and experience excess age-stratified operative and late mortality.
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Lehman et al. (2009) conducted a cohort in Cardiac surgery (n=2,635). Indigenous Australian status vs. Non-Indigenous Australians was evaluated on Operative (30-day) mortality (HR 1.67, 95% CI 0.74-3.75). Indigenous Australian status was associated with a non-significant trend toward excess operative mortality (2.5% vs 1.3%; HR 1.67) and significantly higher euroSCORE-adjusted late mortality (HR 1.46).
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