Racial and socioeconomic disparities in postoperative outcomes following coronary artery bypass grafting: a national inpatient analysis.

backgroundIschemic heart disease (IHD) is the leading cause of death in adults and poses a substantial economic burden in the United States. Coronary artery bypass grafting (CABG) remains the standard surgical intervention for multivessel and left-main coronary disease. However, the combined impact of race and socioeconomic status on CABG outcomes has not been fully explored.

methodsA total of 47,373 admissions of adults (18-85 y) who underwent CABG from 2016-2020 were analysed. Adults aged 18-85 years with a primary diagnosis of IHD who underwent CABG were identified using ICD-10 codes. Data on patient demographics, socioeconomic indicators (household income quartile, insurance type), comorbidities (Charlson Comorbidity Index), and hospital characteristics were collected. Multivariable logistic regression models adjusted for clinical and hospital factors were used to estimate adjusted odds ratios (aORs) for in-hospital mortality, nonhome discharge, prolonged length of stay (> 75th percentile), and postoperative complications. Linear regression assessed differences in hospital costs.

resultsCompared to White patients, Black individuals had significantly higher odds of nonhome discharge (aOR 1.37), prolonged hospitalization (aOR 1.54), and postoperative complications (aOR 1.35) (all p < 0.001). Hispanic and Asian/Pacific Islander patients also faced increased risks of prolonged stay (aORs 1.23-1.26) and complications (aORs 1.15-1.19) (all p < 0.001). Minority groups incurred significantly higher hospitalization costs, with adjusted increases ranging from $17,000 to $73,000 per admission (p < 0.001). Trends toward elevated in-hospital mortality in Native American and Black patients did not reach statistical significance.

conclusionsRacial and socioeconomic disparities persist in CABG outcomes and hospital resource utilization, despite adjustments for clinical and institutional factors. These findings underscore the need for targeted strategies to improve equity in cardiovascular surgical care, including enhanced access to preventive services, perioperative support, and system-level quality improvements. HIGHLIGHTS: Non-Hispanic Black and Hispanic patients experience higher postoperative complication rates and longer hospital stays after CABG. Native American and Black patients showed trends toward higher in-hospital mortality, though not statistically significant. Patients from socioeconomically disadvantaged backgrounds incur significantly higher hospital costs and are more likely to experience prolonged hospitalizations. Racial and socioeconomic disparities persist despite adjustment for comorbidities and hospital-level factors.