Coronary artery bypass grafting at safety-net versus non–safety-net hospitals

• Published in: JTCVS open 2023-03, Vol.13, p.136-149
• Main Authors: Frankel, William C., Sylvester, Christopher B., Asokan, Sainath, Ryan, Christopher T., Zea-Vera, Rodrigo, Zhang, Qianzi, Wall, Matthew J., Markan, Sandeep, Coselli, Joseph S., Rosengart, Todd K., Chatterjee, Subhasis, Ghanta, Ravi K.
• Format: Article
• Language: English
• Subjects: Adult: Coronary; coronary artery bypass grafting; cost; health care disparities; outcomes; safety-net burden; socioeconomic status
• ISSN: 2666-2736; 2666-2736
• DOI: 10.1016/j.xjon.2023.01.008

Safety-net hospitals (SNHs) provide essential services to predominantly underserved patients regardless of their ability to pay. We hypothesized that patients who underwent coronary artery bypass grafting (CABG) would have inferior observed outcomes at SNHs compared with non-SNHs but that matched cohorts would have comparable outcomes. We queried the Nationwide Readmissions Database for patients who underwent isolated CABG from 2016 to 2018. We ranked hospitals by the percentage of all admissions in which the patient was uninsured or insured with Medicaid; hospitals in the top quartile were designated as SNHs. We used propensity-score matching to mitigate the effect of confounding factors and compare outcomes between SNHs and non-SNHs. A total of 525,179 patients underwent CABG, including 96,133 (18.3%) at SNHs, who had a greater burden of baseline comorbidities (median Elixhauser score 8 vs 7; P = .04) and more frequently required urgent surgery (57.1% vs 52.8%; P