Racial and Ethnic Disparities in Major Cardiovascular Events Following Non-Cardiovascular Surgeries.

Persistent racial and ethnic disparities in surgical outcomes remain a critical public health concern, particularly in postoperative cardiovascular complications. We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2018–2022). Adults aged 18 years or older who underwent inpatient non-cardiovascular surgical procedures were included. The primary outcome was a composite 30-day major adverse cardiac, cerebral, and thrombotic event (MACE), including death, myocardial infarction, cardiac arrest, stroke, pulmonary embolism, or deep vein thrombosis. Multivariable logistic regression assessed the association between race and ethnicity and MACE, adjusting for demographic, clinical, and surgical factors. Among 3,775,920 patients, the overall MACE incidence was 1.95%. MACE rates varied by race and ethnicity: 2.11% in Black patients, 1.27% in Hispanic patients, and 2.01% in non-Hispanic White patients. In fully adjusted models, Black patients had significantly higher odds of MACE compared to non-Hispanic White patients (Odds Ratio (OR): 1.11, 95% Confidence Interval (CI): 1.04–1.18), while Hispanic patients had lower odds (OR: 0.88, 95% CI: 0.82–0.95). No statistically significant differences were observed for Asian or Other racial groups. Black patients remain at increased risk of postoperative cardiovascular complications following non-cardiovascular surgery, while Hispanic patients appear to be relatively protected. This pattern aligns with the “Hispanic Paradox,” wherein favorable health outcomes are observed despite socioeconomic disadvantage, although NSQIP does not include acculturation or other social determinants specific data. These findings highlight the importance of addressing persistent disparities and exploring underlying mechanisms to achieve equity in surgical care.