37. Females and Patients with Low Socioeconomic Status Are Less Likely to Undergo Multi-Arterial Grafting
University of Ottawa Heart Institute
Ottawa, ON
Canada - Contact Me
Dr. Marc Ruel is a Professor and the Minimally Invasive Cardiac Surgery Chair at the University of Ottawa Heart Institute. He is the incoming Chief of the Division of Adult Cardiothoracic Surgery and the Helen and Charles Schwab Distinguished Professor of Surgery in the Department of Surgery at the University of California, San Francisco. Dr. Ruel will also serve as Co-Director of the UCSF Health Heart and Vascular Center.
For 11 years, Dr. Ruel served as Chair and Chief of Cardiac Surgery at the University of Ottawa, where he spearheaded remarkable growth in surgical activity, quality, innovation, academic achievements, advanced surgical education, and global outreach.
Dr. Ruel pioneered multiarterial minimally invasive coronary artery bypass surgery worldwide, along with several other cardiac surgical techniques. His career has been dedicated to making cardiac surgery less invasive and achieving better patient outcomes. Dr. Ruel has performed cardiac surgeries as a visiting professor at many institutions around the world and has trained hundreds of heart surgeons from every continent.
A prolific scholar, Dr. Ruel has published 500 scientific papers and chapters, authored six books, and delivered over 350 invited lectures, most of them internationally. His primary textbook on Cardiac Surgical Techniques is now in its third edition and is available in 4 languages. Dr. Ruel leads key international trials in cardiac surgery and is the recipient of numerous academic and public awards, including Queen Elizabeth II’s Diamond Jubilee Medal. The laboratory research program founded by Dr. Ruel (www.beatsresearch.com) has also made significant translational contributions.
Dr. Ruel serves as Surgery Editor for the journal Circulation, Canadian Director for the Society of Thoracic Surgeons, and North American Director for the International Society of Minimally Invasive Cardiothoracic Surgery.
Michigan Medicine
Ann Arbor, MI
United States - Contact Me
Dr. Catherine Wagner is a PGY-5 integrated cardiothoracic surgery resident at the University of Michigan. She is interested in cardiac surgery quality, sex outcomes disparities, and childbearing during training. Dr. Wagner is interested in pursuing a career in academic cardiac surgery.
Description
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.