Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of the Society of Thoracic Surgeons National Cardiac Database
| Autor: | Fred H. Edwards, R. Morton Bolman, Zain Khalpey, Sean M. O'Brien, Lawrence H. Cohn, Minoru Tabata, Joshua D. Grab |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual Coronary Artery Disease Coronary disease computer.software_genre Objective assessment Hospital volume Age Distribution Physiology (medical) medicine Prevalence Humans Sex Distribution Internal Mammary-Coronary Artery Anastomosis Aged Quality of Health Care Database business.industry Racial Groups Odds ratio Middle Aged Confidence interval Surgery medicine.anatomical_structure Cross-Sectional Studies Hospital Bed Capacity Multivariate Analysis Mammary artery Regression Analysis Observational study Female Cardiology and Cardiovascular Medicine business computer Artery |
| Zdroj: | Circulation. 120(11) |
| ISSN: | 1524-4539 |
| Popis: | Background— Use of an internal mammary artery (IMA) is a well-recognized, nationally endorsed quality indicator for evaluating the process of operative care for coronary artery bypass graft surgery. An objective assessment of the current status of IMA use has not been systematically performed. Methods and Results— This cross-sectional observational study analyzed data on 541 368 coronary artery bypass graft surgery procedures reported by 745 hospitals in the Society of Thoracic Surgeons National Cardiac Database from 2002 through 2005. We assessed the current status of IMA use, the association of hospital volume and IMA use, and disparities in IMA use by patient gender and race and by region of hospital location. Rates of using at least 1 IMA and bilateral IMA were 92.4% and 4.0%, with increasing trends over the years. Hospital volume was not significantly associated with IMA use. IMAs were used less frequently in women than men (for at least 1 IMA: odds ratio, 0.62; 95% confidence interval, 0.61 to 0.63; for bilateral IMA: odds ratio, 0.65; 95% confidence interval, 0.63 to 0.68) and less frequently in nonwhite patients than white patients (for at least 1 IMA: odds ratio, 0.84; 95% confidence interval, 0.81 to 0.87; for bilateral IMA: odds ratio, 0.79; 95% confidence interval, 0.75 to 0.83). There were significant differences in frequency of IMA use by hospital region. Conclusions— Frequency of IMA use in coronary artery bypass graft surgery is increasing; however, many patients still do not receive the benefits of IMA grafts, and some hospitals have a very low IMA use rate. Hospital volume is not associated with IMA use in coronary artery bypass graft surgery. Analysis of this critical performance measure reveals significant gender and race disparities. |
| Databáze: | OpenAIRE |
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