Coronary artery bypass surgery: are outcomes influenced by demographics or ability to pay?
OBJECTIVE
To examine the relation of financial status and demographics to the outcomes of coronary artery bypass surgery (CABG) in the public hospital setting.


BACKGROUND
Coronary artery bypass surgery is one of the most expensive and frequently performed surgical procedures in the United States. Considerable controversy surrounds the accessibility to quality cardiac care of indigent and minority populations. This study examines the hypothesis that demographics rather than access to care and economics influences outcomes in CABG.


METHODS
A retrospective review of 1,556 charts of patients who underwent CABG at Louisiana State University Health Sciences Center-Shreveport, a public hospital, during a 10-year period was performed. The parameters analyzed included sex, age, race, education, ejection fraction, comorbidities, surgical parameters, economics, complications, and cost of care. Comparisons were made between the insured and uninsured groups. Univariate statistical analysis was used to assess differences between groups. Kaplan-Meier survival curves were also generated.


RESULTS
Two thirds of the patients were uninsured. The mean age of the uninsured patients was significantly lower than that of the insured patients. Ejection fractions were comparable. Comorbidities were similar, with a greater percentage of tobacco use in the uninsured population. Kaplan-Meier survival curves showed that the uninsured group had better overall survival and that the insured group manifested an increased rate of late death.


CONCLUSIONS
The financially challenged population appears to present for treatment earlier in life with coronary artery disease. Risk factors between the two groups were similar, except that tobacco use appears to be a significant problem in the disadvantaged population. The disease severity in both populations appeared to be similar; however, the uninsured patients had equivalent early survival with better late survival. Access to care in both groups was equal. In the public hospital setting for the disease state described, the financially challenged are afforded access to the current treatment technology with quality results.
Mancini
M C
MC
Department of Surgery, Division of Cardiothoracic Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA. mmanci@lsuhsc
Cush
E M
EM
Sweatman
K
K
Dansby
J
J
D001026:Coronary Artery Bypass / Q000191:economics* / Q000401:mortality*; D005260:Female; D006779:Hospitals, Public / Q000191:economics* / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D017057:Medically Uninsured; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis