On the surface, it looks like good news. While black patients usually have less access than whites to the latest medical technologies, that doesn't seem to be the case when it comes to advanced heart bypass surgery performed while the heart is beating -- but there's a catch.
Blacks more often undergo so-called off-pump coronary artery bypass grafting than whites, but the reason why "is mostly due to surgeries performed by less experienced surgeons," according to a report in the January issue of the Journal of Health Services Research & Policy.
Until recently, coronary artery bypass grafting (CABG) was usually performed with a heart-lung machine, which allows the heart to be stopped while the bypass grafts are sewn in place. While this makes the operation easier, there is evidence that being on the heart lung-machine can cause brain damage in some cases. Performing CABG "off-pump," while the heart is beating normally, is technically demanding and many surgeons are still gaining experience with the technique.
The new findings are based on a study of 15,313 CABG patients who were entered in the New York State Cardiac Surgery Reporting System, which covers all of the surgeons in the state who perform CABG. The procedures included 11,750 on-pump CABG operations and 3563 off-pump procedures.
The study's authors found that 31 percent of black patients had an off-pump operation, significantly more than the 23 percent of white patients and 21 percent of other races. By contrast, no racial difference was seen among those treated by more experienced surgeons.
Therefore, as noted, the reason for the higher number of off-pump CABGs in blacks was largely due to a higher number of surgeons who had performed relatively few of the procedures previously.
"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," says the lead author of the report, Dr. Dana Mukamel from the University of California at Irvine, in a statement.
It's possible, Mukamel continues, that black patients "may be less knowledgeable about treatment options and ... less likely to play an active role in choosing between alternative treatments."
Whatever the reasons for the findings, they "need to be included as part of the ongoing discussions on the access of minorities to quality healthcare."
SOURCE: Journal of Health Services Research & Policy, January 2007.
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