The use of an anesthesia information system to identify and trend gender disparities in outpatient medical management of patients with coronary artery disease.
BACKGROUND
Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery.


METHODS
We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital.


RESULTS
Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4% (1346) had CAD. Patients with CAD: Men were more likely to be taking beta-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking beta-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of beta-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for beta-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic beta-blocker therapy (P < 0.0001 for each medication).


CONCLUSIONS
Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.
Vigoda
Michael M
MM
Center for Informatics and Perioperative Management, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA. mvigoda@med.miami.edu
Rodríguez
Luis I
LI
Wu
Eric
E
Perry
Kevin
K
Duncan
Robert
R
Birnbach
David J
DJ
Lubarsky
David A
DA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000758:Anesthesia; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011300:Preoperative Care; D012189:Retrospective Studies; D012727:Sex Characteristics
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin