Non-Hispanic Black patients were less likely to undergo minimally invasive mitral valve surgery compared with non-Hispanic White patients (aOR 0.88; 95% CI 0.78-0.99; P=.04).
Cross-Sectional (n=103,753)
Yes
Does race and ethnicity affect the utilization of minimally invasive mitral valve surgery in patients undergoing mitral valve surgery?
Non-Hispanic Black patients face significant disparities in access to minimally invasive mitral valve surgery and experience worse clinical outcomes compared to non-Hispanic White patients.
Odds Ratio: 0.88 (95% CI 0.78–0.99)
p-value: p=.04
Importance: Whether people from racial and ethnic minority groups experience disparities in access to minimally invasive mitral valve surgery (MIMVS) is not known. Objective: To investigate racial and ethnic disparities in the utilization of MIMVS. Design, Setting, and Participants: This cross-sectional study used data from the Society of Thoracic Surgeons Database for patients who underwent mitral valve surgery between 2014 and 2019. Statistical analysis was performed from January 24 to August 11, 2022. Exposures: Patients were categorized as non-Hispanic White, non-Hispanic Black, and Hispanic individuals. Main Outcomes and Measures: The association between MIMVS (vs full sternotomy) and race and ethnicity were evaluated using logistic regression. Results: Among the 103 753 patients undergoing mitral valve surgery (mean SD age, 62 13 years; 47 886 female individuals 46.2%), 10 404 (10.0%) were non-Hispanic Black individuals, 89 013 (85.8%) were non-Hispanic White individuals, and 4336 (4.2%) were Hispanic individuals. Non-Hispanic Black individuals were more likely to have Medicaid insurance (odds ratio OR, 2.21; 95% CI, 1.64-2.98; P < .001) and to receive care from a low-volume surgeon (OR, 4.45; 95% CI, 4.01-4.93; P < .001) compared with non-Hispanic White individuals. Non-Hispanic Black individuals were less likely to undergo MIMVS (OR, 0.65; 95% CI, 0.58-0.73; P < .001), whereas Hispanic individuals were not less likely to undergo MIMVS compared with non-Hispanic White individuals (OR, 1.08; 95% CI, 0.67-1.75; P = .74). Patients with commercial insurance had 2.35-fold higher odds of undergoing MIMVS (OR, 2.35; 95% CI, 2.06-2.68; P < .001) than those with Medicaid insurance. Patients operated by very-high volume surgeons (300 or more cases) had 20.7-fold higher odds (OR, 20.70; 95% CI, 12.7-33.9; P < .001) of undergoing MIMVS compared with patients treated by low-volume surgeons (less than 20 cases). After adjusting for patient risk, non-Hispanic Black individuals were still less likely to undergo MIMVS (adjusted OR aOR, 0.88; 95% CI, 0.78-0.99; P = .04) and were more likely to die or experience a major complication (aOR, 1.25; 95% CI, 1.16-1.35; P < .001) compared with non-Hispanic White individuals. Conclusions and Relevance: In this cross-sectional study, non-Hispanic Black patients were less likely to undergo MIMVS and more likely to die or experience a major complication than non-Hispanic White patients. These findings suggest that efforts to reduce inequity in cardiovascular medicine may need to include increasing access to private insurance and high-volume surgeons.
Glance et al. (Wed,) conducted a cross-sectional in Mitral valve surgery (n=103,753). Non-Hispanic Black race/ethnicity vs. Non-Hispanic White race/ethnicity was evaluated on Utilization of minimally invasive mitral valve surgery (MIMVS) (aOR 0.88, 95% CI 0.78-0.99, p=.04). Non-Hispanic Black patients were less likely to undergo minimally invasive mitral valve surgery compared with non-Hispanic White patients (aOR 0.88; 95% CI 0.78-0.99; P=.04).