Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD.
Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD.
Ann Surg. 2020 Oct;272(4):660-667. doi: 10.1097/SLA.0000000000004335.
The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG.
Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated.
We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission.
The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05-1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21-1.30).
In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be unknown or underappreciated biological mechanisms at play, future research should focus on socioeconomic, cultural, and multilevel factors.
本研究旨在评估 2011 年至 2018 年间行冠状动脉旁路移植术（CABG）的患者按种族分组的 30 天死亡率的时间趋势，并探讨种族和性别对 CABG 术后结局的影响。
心血管疾病仍是美国的主要死亡原因，研究表明，黑人患者和女性患者在接受手术后发病率和死亡率更高。在药物洗脱支架时代之后，有关 CABG 种族差异的研究已经过时。
我们对 2011 年至 2018 年间行 CABG 的胸外科医师协会数据库进行了回顾性分析。主要结局为 30 天死亡率。次要结局包括术后住院时间、手术部位感染、败血症、肺炎、中风、再次手术、再次介入、早期拔管和再入院。
本研究人群包括 2011 年至 2018 年间行单纯 CABG 的 1042506 例患者。在所有种族中，黑人患者术前合并症发生率更高。与白人患者相比，黑人患者的总死亡率更高（2.76%比 2.19%，P<0.001）。单变量回归显示，与白人患者相比，黑人患者的死亡、感染、肺炎和术后中风发生率更高。多变量回归显示，与白人患者相比，黑人患者 30 天死亡率的几率更高[比值比（OR）=1.11，95%置信区间（CI）1.05-1.18]。同样，女性患者的死亡几率高于男性（OR=1.26，95%CI 1.21-1.30）。
在现代，冠状动脉旁路手术后死亡率和术后发病率的种族和性别差异仍然存在，黑人患者和女性患者的结局始终比白人男性患者差。尽管可能存在未知或未被充分认识的生物学机制，但未来的研究应侧重于社会经济、文化和多层次因素。
