Females and Patients with Low Socioeconomic Status Are Less Likely to Undergo Multi-Arterial Grafting
Presented During:
Saturday, May 6, 2023: 10:00AM - 10:15AM
Los Angeles Convention Center
Posted Room Name:
515A
Abstract No:
37
Submission Type:
Abstract Submission
Authors:
Catherine Wagner (1), Patricia Theurer (2), Chang He (3), Fouad Azoury (4), Hisham Qandeel (5), Dimitrios Magouliotis (3), James Martin (6), Andrew Pruitt (7), Ahmet Topcu (8), Gorav Ailawadi (9), Donald Likosky, PhD (9), Michael Thompson (9), Francis Pagani (10), Robert Hawkins (9)
Institutions:
(1) Michigan Medicine, Ypsilanti, MI, (2) N/A, Ann Arbor, MI, (3) Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, (4) N/A, N/A, (5) N/A, Rochester, MN, (6) Ascension, Detroit, MI, (7) St joseph Mercy Hospital, Ann Arbor, MI, (8) Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Detroit, MI, (9) University of Michigan, Ann Arbor, MI, (10) Michigan Medicine - University of Michigan, Ann Arbor, MI
Submitting Author:
Catherine Wagner
-
Contact Me
Michigan Medicine
Michigan Medicine
Co-Author(s):
Patricia Theurer
-
Contact Me
N/A
N/A
Chang He
-
Contact Me
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Fouad Azoury
-
Contact Me
N/A
N/A
Hisham Qandeel
-
Contact Me
N/A
N/A
Dimitrios Magouliotis
-
Contact Me
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
James Martin
-
Contact Me
Ascension
Ascension
Andrew Pruitt
-
Contact Me
St joseph Mercy Hospital
St joseph Mercy Hospital
Ahmet Can Topcu
-
Contact Me
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
*Gorav Ailawadi
-
Contact Me
University of Michigan
University of Michigan
Donald Likosky, PhD
-
Contact Me
University of Michigan
University of Michigan
Michael Thompson
-
Contact Me
University of Michigan
University of Michigan
*Francis Pagani
-
Contact Me
Michigan Medicine - University of Michigan
Michigan Medicine - University of Michigan
Robert Hawkins
-
Contact Me
University of Michigan
University of Michigan
Presenting Author:
Catherine Wagner
-
Contact Me
Michigan Medicine
Michigan Medicine
Abstract:
Objective: Females and patients with low socioeconomic status have poorer healthcare access with greater outcome inequities. We examined association of female sex and low socioeconomic status with rate of multiarterial grafting (MAG) during coronary artery bypass grafting (CABG) to advance quality for these priority populations.
Methods: Patients undergoing isolated CABG with two or more bypass grafts from 2011 to 2022 were evaluated in a statewide collaborative database. Patients with a history of mediastinal radiation, prior cardiac surgery, emergent/salvage status, and subclavian stenosis were excluded. Patients were stratified by the distressed community index (DCI) score, a socioeconomic ranking by zip code (scale of 0-100, 100 being the most distressed). Hierarchical regression modeling was performed to associate DCI and sex with MAG, incorporating patient factors (e.g., age, BMI, diabetes, creatinine) and surgery year, with hospital and surgeon as random effects.
Results: A total of 39,004 patients underwent CABG at 33 centers. The mean age was 66±10 years and 24% (n=9,388) were female. Compared to males, females lived in zip codes associated with higher median DCI (51 [IQR 24, 72] vs 42 [IQR 17, 66]), p<0.001). The overall rate of MAG was 15% and was lower among females (10% versus 17%, p<0.001). Overall adjusted odds of receiving MAG increased throughout the study period (2012 vs 2018, OR 0.20 [95% CI 0.17-0.22], p<0.001). After multivariable adjustment, females were less likely to receive MAG compared to males (OR 0.51 [95% CI 0.45-0.58], p<0.001) (Figure). Similarly, patients living in zip codes with a higher DCI score had lower adjusted odds of receiving MAG (OR 0.90 per 10-point increase [95% CI 0.87-0.94], p<0.001). There was no association between Black race (vs White race) and MAG (OR 0.88 [95% CI 0.76-1.02] p=0.24). The impact of DCI and sex on MAG did not change by surgery-year (p>0.05) suggesting these effects did not change over time.
Conclusions: After risk adjustment, females are half as likely to undergo MAG during CABG than males. Similarly, patients from low socioeconomic status are less likely to receive MAG, even after accounting for risk and hospital. These disparity gaps persisted even though the overall rate of MAG increased over time. Increased attention to identify and address barriers to MAG in these populations is required to provide more equitable surgical revascularization practices.
Methods: Patients undergoing isolated CABG with two or more bypass grafts from 2011 to 2022 were evaluated in a statewide collaborative database. Patients with a history of mediastinal radiation, prior cardiac surgery, emergent/salvage status, and subclavian stenosis were excluded. Patients were stratified by the distressed community index (DCI) score, a socioeconomic ranking by zip code (scale of 0-100, 100 being the most distressed). Hierarchical regression modeling was performed to associate DCI and sex with MAG, incorporating patient factors (e.g., age, BMI, diabetes, creatinine) and surgery year, with hospital and surgeon as random effects.
Results: A total of 39,004 patients underwent CABG at 33 centers. The mean age was 66±10 years and 24% (n=9,388) were female. Compared to males, females lived in zip codes associated with higher median DCI (51 [IQR 24, 72] vs 42 [IQR 17, 66]), p<0.001). The overall rate of MAG was 15% and was lower among females (10% versus 17%, p<0.001). Overall adjusted odds of receiving MAG increased throughout the study period (2012 vs 2018, OR 0.20 [95% CI 0.17-0.22], p<0.001). After multivariable adjustment, females were less likely to receive MAG compared to males (OR 0.51 [95% CI 0.45-0.58], p<0.001) (Figure). Similarly, patients living in zip codes with a higher DCI score had lower adjusted odds of receiving MAG (OR 0.90 per 10-point increase [95% CI 0.87-0.94], p<0.001). There was no association between Black race (vs White race) and MAG (OR 0.88 [95% CI 0.76-1.02] p=0.24). The impact of DCI and sex on MAG did not change by surgery-year (p>0.05) suggesting these effects did not change over time.
Conclusions: After risk adjustment, females are half as likely to undergo MAG during CABG than males. Similarly, patients from low socioeconomic status are less likely to receive MAG, even after accounting for risk and hospital. These disparity gaps persisted even though the overall rate of MAG increased over time. Increased attention to identify and address barriers to MAG in these populations is required to provide more equitable surgical revascularization practices.
DIVERSITY, EQUITY, INCLUSION:
Barriers to Care, Social Determinants of Care and Outcomes
Image or Table
