دورية أكاديمية
أعرض في EDS

Safety-Net Hospital Status Is Associated With Coronary Artery Bypass Grafting Outcomes at an Urban Academic Medical Center.

التفاصيل البيبلوغرافية
العنوان: Safety-Net Hospital Status Is Associated With Coronary Artery Bypass Grafting Outcomes at an Urban Academic Medical Center.
المؤلفون: Chandra R; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas., Meier J; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas., Marshall N; Parkland Memorial Hospital, Dallas, Texas; School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., Chuckaree I; Parkland Memorial Hospital, Dallas, Texas; School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., Harirah O; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas., Khoury MK; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas., Ring WS; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Peltz M; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Wait MA; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Jessen ME; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Hackmann AE; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Heid CA; Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Christopher.Heid@utsouthwestern.edu.
المصدر: The Journal of surgical research [J Surg Res] 2024 Feb; Vol. 294, pp. 112-121. Date of Electronic Publication: 2023 Oct 20.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE
أسماء مطبوعة: Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
مواضيع طبية MeSH: Myocardial Infarction*/epidemiology , Myocardial Infarction*/etiology , Coronary Artery Disease*/epidemiology , Coronary Artery Disease*/surgery, Adult ; Humans ; Safety-net Providers ; Coronary Artery Bypass/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Academic Medical Centers ; Treatment Outcome ; Risk Factors ; Retrospective Studies
مستخلص: Introduction: Socioeconomic disparities impact outcomes after cardiac surgery. At our institution, cardiac surgery cases from the safety-net, county funded hospital (CH), which primarily provides care for underserved patients, are performed at the affiliated university hospital. We aimed to investigate the association of socioeconomic factors and CH referral status with outcomes after coronary artery bypass grafting (CABG).
Methods: The institutional Adult Cardiac Surgery database was queried for perioperative and demographic data from patients who underwent isolated CABG between January 2014 and June 2020. The primary outcome was major adverse cardiovascular event (MACE), a composite of postoperative myocardial infarction, stroke, or death. Secondary outcomes included individual complications. Chi-square, Wilcoxon rank-sum, and logistic regression analyses were used to compare differences between CH and non-CH cohorts.
Results: We included 836 patients with 472 (56.5%) from CH. Compared to the non-CH cohort, CH patients were younger, more likely to be Hispanic, non-English speaking, and be completely uninsured or require state-specific financial assistance. CH patients were more likely to have a history of tobacco and drug use, liver disease, diabetes, prior myocardial infarction, and greater degrees of left main coronary and left anterior descending artery stenosis. CH cases were less likely to be elective. The incidence of MACE was significantly higher in the CH cohort (16.3% versus 8.2%, P = 0.001). There were no significant differences in 30-d mortality, home discharge, prolonged mechanical ventilation, bleeding, sepsis, pneumonia, new dialysis requirement, cardiac arrest, or multiorgan system failure between cohorts. CH patients were more likely to develop renal failure and less likely to develop atrial fibrillation. On multivariable analysis, CH status (odds ratio 2.39, 95% confidence interval 1.25-4.55, P = 0.008) was independently associated with MACE.
Conclusions: CH patients undergoing CABG presented with greater comorbidity burden, more frequently required nonelective surgery, and are at significantly higher risk of postoperative MACE.
(Published by Elsevier Inc.)
فهرسة مساهمة: Keywords: Coronary artery bypass grafting; Major adverse cardiovascular event; Postoperative outcomes; Safety-net county hospitals; Socioeconomic disparities
تواريخ الأحداث: Date Created: 20231022 Date Completed: 20231205 Latest Revision: 20240708
رمز التحديث: 20240708
DOI: 10.1016/j.jss.2023.08.046
PMID: 37866066
قاعدة البيانات: MEDLINE
الوصف
تدمد:1095-8673
DOI:10.1016/j.jss.2023.08.046