Key result
Black race is linked to ~19% higher post-CABG mortality vs. White patients, unexplained by hospital volume.
Why the study?
Low hospital volume predicts mortality for cardiovascular procedures and could be an important mediator explaining racial and ethnic differences in post-procedure mortality.
Does hospital volume explain racial and ethnic disparities in post-procedure in-hospital mortality among patients undergoing major cardiovascular procedures?
Cohort (n=719,679)
Yes
Does hospital volume explain racial and ethnic disparities in post-procedure in-hospital mortality among patients undergoing major cardiovascular procedures?
Although Black and Hispanic patients are more likely to undergo cardiovascular procedures at low-volume hospitals, hospital volume does not account for a large proportion of the excess post-procedure mortality observed in Black patients.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“One, clinicians should recognize that black patients face markedly higher mortality after some cardiovascular procedures, with up to a twofold increase in the risk of postprocedure death; and two, although better access to high-volume hospitals may improve outcomes for both white and minority patients, this increased use of high-volume hospitals is unlikely to eliminate racial differences in postprocedure mortality.”
“Participation in established national registries to facilitate benchmarking of care, coupled with new technologies such as medical simulation training, holds great promise for improving quality of care and outcomes after cardiovascular procedures for the US as a whole. It is hoped that these efforts will close the racial gap in quality of care and outcomes, but [they] will require special effort and support in hospitals that treat underserved populations.”
Racial disparities in post-procedure mortality persist beyond hospital volume; leaves open unmeasured systemic factors and requires prospective confirmation.
Objectives We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality. Background Low hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes. Methods We analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA) from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality. Results Black and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.20 to 2.84), CABG (OR, 1.19; 95% CI, 1.06 to 1.33), and CEA (OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients. Conclusions Black and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.
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Trivedi et al. (2006) conducted a cohort in Major cardiovascular procedures (CABG, PTCA, AAA repair, CEA) (n=719,679). Black or Hispanic race/ethnicity and treatment at low-volume hospitals vs. White race/ethnicity was evaluated on Post-procedure in-hospital mortality (specifically shown here for CABG) (OR 1.19, 95% CI 1.06-1.33). Black race was associated with higher mortality after CABG (OR 1.19; 95% CI 1.06-1.33), AAA repair (OR 1.84), and CEA (OR 1.56) vs white patients, largely unexplained by hospital volume.
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