Young surgeons performing coronary surgery on black patients

Armen Hareyan's picture
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Cardiac surgeons who are less experienced with the recently introduced off-pump techniques in coronary bypass surgery are more likely to perform such operations on black patients, according to US researchers.

Writing in the Royal Society of Medicine's, Journal of Health Services Research & Policy, the findings are based on over 15,000 coronary artery bypass grafting (CABG) patients in New York State.

Traditionally, CABG is performed using the cardiopulmonary bypass to circulate blood externally during the operation, giving the surgeon a stable and blood-free environment in which to operate. The use of the cardiopulmonary bypass is not without risk and many cardiac surgeons associate it with serious complications, including cognitive deficits, stroke, renal failure, and pulmonary dysfunction.

Off-pump surgery, which is performed on the beating heart without the use of the cardiopulmonary bypass, was reintroduced in the late 1990s because many surgeons believed it may decrease the incidence of complications.

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"Our research shows that surgeons who have less experience with the off-pump technique are more likely to perform this technique on black patients, rather than on white patients," said Professor Dana Mukamel of the University of California, Irvine.

"Racial disparities in access to heath care are well known throughout the United States. Black and minority groups usually do not have as much access as white patients to the latest technologies in medical care. However, in the case of off-pump CABG surgery they have more access, which is mostly due to surgeries performed by less experienced surgeons."

The researchers examined 15,313 CABG patients and found: 31% of black and 23% of white CABG patients underwent off-pump surgery. The higher rates of black patients arose mostly from surgeons who perform fewer off-pump procedures rather than surgeons who perform many off-pump surgeries. The researchers found no significant differences between black and white patients treated by surgeons performing many off-pump surgeries.

"The data show that surgeons who perform fewer off-pump procedures are more likely to perform this new procedure on black patients, who may be less knowledgeable about treatment options and who are less likely to play an active role in choosing between alternative treatments," said Professor Mukamel

"Whether this is intentional or unintentional, whether it can be explained by other factors, and whether this applies to other new technologies, needs to be the subject of further research and investigation. However, these findings need to be included as part of the ongoing discussions on the access of minorities to quality healthcare."

An accompanying editorial in the Journal of Health Services Research & Policy outlines the development of the off-pump procedure in CABG surgery and the growing pressure for surgeons to adopt the technique.

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