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Relation of Race, Ethnicity and Cardiac Surgeons to Operative Mortality Rates in Primary Coronary Artery Bypass Grafting in California

  • Luis R. Castellanos
    Affiliations
    Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California

    Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
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  • Zhongmin Li
    Affiliations
    Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California
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  • Khung Keong Yeo
    Affiliations
    Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California

    Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
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  • J. Nilas Young
    Affiliations
    Department of Surgery and Division of Cardiothoracic Surgery, University of California, Davis Medical Center, Sacramento, California
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  • John Z. Ayanian
    Affiliations
    Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, Boston, Massachusetts

    Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, Boston, Massachusetts

    Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
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  • Ezra A. Amsterdam
    Correspondence
    Corresponding author: Tel: 916-734-3764; fax: 916-734-8394
    Affiliations
    Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California

    Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
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      The aim of this study was to evaluate whether African American, Hispanic, and Asian patients in California were more likely to undergo coronary artery bypass grafting (CABG) by cardiac surgeons with higher risk-adjusted mortality rates (RAMRs). Clinical data from the California CABG Outcomes Reporting Program were analyzed for all patients who underwent isolated CABG from 2003 to 2006 by surgeons who performed ≥10 operations. Surgeons were divided into quintiles on the basis of their RAMRs, with the top-performing surgeons in the first quintile and the lowest performing surgeons in the fifth quintile. There were 72,845 isolated CABG procedures performed by 303 surgeons, including 49,886 in white, 9,380 in Hispanic, 6,867 in Asian, and 2,750 in African American patients. African American and Asian patients underwent CABG by surgeons with higher mean RAMRs (2.90% and 2.99%, respectively) compared with the state average of 2.65% (p <0.001). Compared to white patients, Asian and Hispanic patients were more likely to be treated by surgeons in the lowest quintile (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.11 to 1.3, and OR 1.38, 95% CI 1.30 to 1.48, respectively). African Americans and Hispanics were less likely to be operated on by surgeons in the top quintile compared to white patients (OR 0.80, 95% CI 0.71 to 0.90, and OR 0.81, 95% CI 0.76 to 0.87, respectively). Hispanics were less likely to be treated by surgeons in the top quintile than by surgeons in the lowest quintile (OR 0.65, 95% CI 0.60 to 0.75). In conclusion, racial and ethnic minority patients who undergo isolated CABG in California may be more likely to be operated on by cardiac surgeons with higher RAMRs.
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