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Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()

BACKGROUND: High-volume surgeons and hospitals performing coronary artery bypass grafting have been associated with improved patient outcomes. However, patients of increased socioeconomic distress may have worse outcomes because of health care disparities. We sought to identify trends and outcomes i...

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Autores principales: Rogers, Michael P., Janjua, Haroon M., Kuo, Paul C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249902/
https://www.ncbi.nlm.nih.gov/pubmed/35789961
http://dx.doi.org/10.1016/j.sopen.2022.05.010
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author Rogers, Michael P.
Janjua, Haroon M.
Kuo, Paul C.
author_facet Rogers, Michael P.
Janjua, Haroon M.
Kuo, Paul C.
author_sort Rogers, Michael P.
collection PubMed
description BACKGROUND: High-volume surgeons and hospitals performing coronary artery bypass grafting have been associated with improved patient outcomes. However, patients of increased socioeconomic distress may have worse outcomes because of health care disparities. We sought to identify trends and outcomes in patients of elevated distress undergoing bypass grafting. METHODS: The Florida Agency for Healthcare Administration administrative data set was merged with Centers for Medicare and Medicaid Services Physician and Hospital Compare and Economic Innovation Group Distressed Community Index data sets to build a comprehensive database. The data set was queried to identify patients undergoing coronary artery bypass procedures between 2016 and 2020. High- and low-volume hospitals and surgeons were compared. Patient and hospital demographics, comorbidities, length of stay, and postoperative complications were analyzed by χ(2) and t test where appropriate. RESULTS: A total of 41,571 coronary artery bypass grafting procedures were performed by 174 surgeons at 67 Florida hospitals. Low- and high-volume hospitals did not differ with respect to hospital ownership, overall star rating, national comparisons of mortality, readmission, or cost effectiveness. Patients from at-risk and distressed communities were more likely to undergo surgery at low-volume hospitals. Hospital length of stay was increased for low-volume hospitals (10.2 vs 9.4 days, P < .05). Postoperative complications including pneumonia, arrhythmia, respiratory failure, acute renal failure, shock, pleural effusion, and sepsis were more frequent at low-volume hospitals and for low-volume surgeons. CONCLUSION: High-volume hospitals and surgeons have improved postoperative outcomes and hospital length of stay when compared to low-volume hospitals and surgeons performing coronary artery bypass grafting. At-risk and distressed populations are more likely to undergo bypass surgery at low-volume hospitals, potentially contributing to worse patient outcome. Efforts should be made to mitigate the potential impact of low socioeconomic status to improve outcomes in this population.
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spelling pubmed-92499022022-07-03 Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals() Rogers, Michael P. Janjua, Haroon M. Kuo, Paul C. Surg Open Sci Original Article BACKGROUND: High-volume surgeons and hospitals performing coronary artery bypass grafting have been associated with improved patient outcomes. However, patients of increased socioeconomic distress may have worse outcomes because of health care disparities. We sought to identify trends and outcomes in patients of elevated distress undergoing bypass grafting. METHODS: The Florida Agency for Healthcare Administration administrative data set was merged with Centers for Medicare and Medicaid Services Physician and Hospital Compare and Economic Innovation Group Distressed Community Index data sets to build a comprehensive database. The data set was queried to identify patients undergoing coronary artery bypass procedures between 2016 and 2020. High- and low-volume hospitals and surgeons were compared. Patient and hospital demographics, comorbidities, length of stay, and postoperative complications were analyzed by χ(2) and t test where appropriate. RESULTS: A total of 41,571 coronary artery bypass grafting procedures were performed by 174 surgeons at 67 Florida hospitals. Low- and high-volume hospitals did not differ with respect to hospital ownership, overall star rating, national comparisons of mortality, readmission, or cost effectiveness. Patients from at-risk and distressed communities were more likely to undergo surgery at low-volume hospitals. Hospital length of stay was increased for low-volume hospitals (10.2 vs 9.4 days, P < .05). Postoperative complications including pneumonia, arrhythmia, respiratory failure, acute renal failure, shock, pleural effusion, and sepsis were more frequent at low-volume hospitals and for low-volume surgeons. CONCLUSION: High-volume hospitals and surgeons have improved postoperative outcomes and hospital length of stay when compared to low-volume hospitals and surgeons performing coronary artery bypass grafting. At-risk and distressed populations are more likely to undergo bypass surgery at low-volume hospitals, potentially contributing to worse patient outcome. Efforts should be made to mitigate the potential impact of low socioeconomic status to improve outcomes in this population. Elsevier 2022-05-20 /pmc/articles/PMC9249902/ /pubmed/35789961 http://dx.doi.org/10.1016/j.sopen.2022.05.010 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Rogers, Michael P.
Janjua, Haroon M.
Kuo, Paul C.
Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title_full Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title_fullStr Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title_full_unstemmed Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title_short Disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
title_sort disparities in coronary artery bypass grafting between high- and low-volume surgeons and hospitals()
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249902/
https://www.ncbi.nlm.nih.gov/pubmed/35789961
http://dx.doi.org/10.1016/j.sopen.2022.05.010
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