Advertisement
JTCVS Open
Advanced searchSave search
Research Article|Articles in Press

Download started.

Ok

Coronary artery bypass grafting at safety-net versus non–safety-net hospitals

Open AccessPublished:January 23, 2023DOI:https://doi.org/10.1016/j.xjon.2023.01.008
Coronary artery bypass grafting at safety-net versus non–safety-net hospitals
Previous ArticleBuilding Cardiac Surgical Programs in Lower- Middle Income Countries
Next ArticleIn Silico Analysis Provides Insights for Patient-Specific Annuloplasty in Barlow´s Disease
      This paper is only available as a PDF. To read, Please Download here.

      ABSTRACT

      Objective

      Safety-net hospitals (SNHs) provide essential services to predominantly underserved patients regardless of their ability to pay. We hypothesized that patients who underwent coronary artery bypass grafting (CABG) would have inferior observed outcomes at SNHs compared with non-SNHs but that matched cohorts would have comparable outcomes.

      Methods

      We queried the Nationwide Readmissions Database for patients who underwent isolated CABG from 2016–2018. We ranked hospitals by the percentage of all admissions in which the patient was uninsured or insured with Medicaid; hospitals in the top quartile were designated as SNHs. We used propensity-score matching to mitigate the effect of confounding factors and compare outcomes between SNHs and non-SNHs.

      Results

      A total of 525,179 patients underwent CABG, including 96,133 (18.3%) at SNHs, who had a greater burden of baseline comorbidities (median Elixhauser score 8 vs 7; P =.04) and more frequently required urgent surgery (57.1% vs 52.8%; P <.001). Observed in-hospital mortality (2.1% vs 1.8%; P =.004) and major morbidity, length of stay (9 vs 8 days; P <.001), cost ($46,999 vs $38,417; P <.001), and readmission rate at 30 (12.4% vs 11.3%) and 90 days (19.0% vs 17.7%) were greater at SNHs (both P <.001). After matching, none of these differences persisted except length of stay (9 vs 8 days) and cost ($46,977 vs $39,343) (both P <.001).

      Conclusions

      After matching, early outcomes after CABG were comparable at SNHs and non-SNHs. Improved discharge resources could reduce length of stay and curtail cost, improving the value of CABG at SNHs.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Abbreviations and Acronyms:

      AHRQ (Agency for Healthcare Research and Quality), CABG (Coronary artery bypass grafting), CI (Confidence interval), HCUP (Healthcare Cost and Utilization Project), LOS (Length of stay), NRD (Nationwide Readmissions Database), OR (Odds ratio), SNH (Safety-net hospital)

      Article info

      Publication history

      Accepted: January 10, 2023
      Received: June 15, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Read at the American College of Surgeons 107th Annual Clinical Congress, Scientific Forum, Washington, DC, October 23-27, 2021.

      Disclosure statement: The authors having nothing to disclose with regard to commercial support.

      Funding statement: No funding was received for this work.

      CENTRAL PICTURE LEGEND: Early outcomes after CABG are comparable at safety-net and non–safety-net hospitals.

      CENTRAL MESSAGE

      Safety-net hospitals perform coronary artery bypass grafting with comparable early outcomes to those of propensity-matched non–safety-net hospitals but with longer stays and higher costs.

      PERSPECTIVE

      Although previous studies have suggested that the quality of complex surgical care at safety-net hospitals lags behind non–safety-net hospitals, we found that safety-net hospitals perform coronary artery bypass grafting with comparable propensity-score matched outcomes to non–safety-net hospitals, albeit with longer length of stay and higher costs.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.01.008

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

      User license

      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) |
      How you can reuse Information Icon
      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)

      Permitted

      For non-commercial purposes:

      • Read, print & download
      • Redistribute or republish the final article
      • Text & data mine
      • Translate the article (private use only, not for distribution)
      • Reuse portions or extracts from the article in other works

      Not Permitted

      • Sell or re-use for commercial purposes
      • Distribute translations or adaptations of the article

      Elsevier's open access license policy

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX