Dataset Information

Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study.

ABSTRACT:

Background

Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long-term outcomes following CABG.

Method and results

Using administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow-up was 9.1±3.9 years. SA were younger (SA: 61.7±9.4, GP: 64.1±10.0 years, standardized difference=0.25) with more cardiac risk factors, including diabetes (SA: 54.1%, GP: 34.9%, standardized difference =0.40). Propensity-score matching resulted in 2473 matched pairs between SA and GP with all baseline covariates being balanced (standardized difference <0.1). Being a SA compared to the GP was protective against freedom from major adverse cardiac and cerebrovascular events, defined by all-cause death, myocardial infarction, stroke, or coronary reintervention: Adjusted Cox-proportional hazard ratio 0.91, 95% CI (0.83-0.99), adjusted-P=0.04; this was also true for freedom from all-cause mortality: hazard ratio 0.81, 95% CI (0.72-0.91), adjusted P=0.0004. The adjusted proportion of major adverse cardiac and cerebrovascular events was lower in the SA (SA: 34.7%, GP: 37.8%, McNemar P=0.03), driven largely by all-cause mortality (SA: 20.4%, GA: 24.3%, McNemar P=0.001).

Conclusions

Contrary to existing notions, our study finds that being a SA is protective with respect to freedom from long-term major adverse cardiac and cerebrovascular events and mortality after CABG. More studies are required to corroborate and explore causal factors of these findings.

SUBMITTER: Deb S

PROVIDER: S-EPMC5015415 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Publications

Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study.

Deb Saswata S Tu Jack V JV Austin Peter C PC Ko Dennis T DT Rocha Rodolfo R Mazer C David CD Kiss Alex A Fremes Stephen E SE

Journal of the American Heart Association 20160722 7

<h4>Background</h4>Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long-term outcomes following CABG.<h4>Metho ...[more]

PMID: 27451460

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Project description:BACKGROUND:To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. METHODS AND RESULTS:We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices ("MI-CollaborativePlus"), whereas 15 did not ("MI-CollaborativeOnly"). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the preintervention period (Q3/2011 through Q3/2012), there was no statistically significant difference in the adjusted odds of pneumonia for STS hospitals participating in the MI-Collaborative compared to the STS non-MI hospitals. However, during the intervention period (Q4/2012 through Q2/2017), there was a significant 2% reduction per quarter in the adjusted odds of pneumonia for MI-Collaborative hospitals (n=33) relative to the STS-nonMI hospitals. There was a significant 3% per quarter reduction in the adjusted odds of pneumonia for the MI-CollaborativeOnly (n=15) hospitals relative to the STS-nonMI hospitals. Over the course of the overall study period, the STS-nonMI hospitals had a 1.96% reduction in risk-adjusted pneumonia (pre- vs. intervention periods), which was less than the MI-Collaborative (3.23%, P=0.011). Over the same time period, the MI-CollaborativePlus (n=18) reduced adjusted pneumonia rates by 10.29%, P=0.001. CONCLUSIONS:Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting. CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.

Dataset Information

Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study.

Background

Method and results

Conclusions

Publications

Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study.

Similar Datasets

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