title: Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  To examine explanations of differences in utilization rates of a newly reintroduced technique - off-pump coronary artery bypass grafting (CABG) - between racial minorities and Whites.
  
  
  METHODS
  The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of off-pump versus on-pump surgery.
  
  
  RESULTS
  Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent off-pump CABG (P <0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks treated by surgeons with low volume off-pump procedures were 1.9 times (P <0.01) more likely to have off-pump surgery compared with Whites treated by the same surgeons. There were no significant differences between Blacks and Whites treated by high volume surgeons.
  
  
  CONCLUSIONS
  These findings suggest that surgeons who are inexperienced with the off-pump techniques are more likely to perform this surgery on Black patients. Further research should examine potential explanations and the agenda addressing racial disparities should be expanded to address issues of treatment decisions.
authors.affiliation: Department of Medicine, Center for Health Policy Research, University of California, Irvine, CA, USA. dmukamel@uci.edu
authors.forename: Dana
authors.initials: D
authors.lastname: Mukamel
authors.forename: Laurent
authors.initials: L
authors.lastname: Glance
authors.forename: David
authors.initials: D
authors.lastname: Weimer
authors.forename: Thomas
authors.initials: T
authors.lastname: Pearson
authors.forename: Todd
authors.initials: T
authors.lastname: Massey
authors.forename: Jeffery
authors.initials: J
authors.lastname: Gold
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: James
authors.initials: J
authors.lastname: Jackson
authors.forename: Alvin
authors.initials: A
authors.lastname: Mushlin
mesh_terms: D001741:Black or African American; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000379:methods*; D003430:Cross-Sectional Studies; D003657:Decision Making; D006801:Humans; D009518:New York