UC Irvine researches may have a discouraging explanation for why certain coronary bypass surgery patients in New York, NY are getting young and inexperienced doctors.
Professor Dana Mukamel and his research group have found a difference between black heart surgery patients and white heart surgery patients and the level of experience of doctors performing the surgery.
‘Our research shows that surgeons who have less experience with the off-pump technique are more likely to perform [the off-pump] technique on black patients, rather than on white patients,’ Professor Dana Mukamel said in a Royal Society of Medicine press release. ‘Racial disparities in access to health care are well known throughout the United States. Black and minority groups usually do not have as much access as white patients to the latest technologies in medical care. However, in the case of off-pump coronary artery bypass grafting surgery they have more access, which is mostly due to surgeries performed by less experienced surgeons.’
The findings are based on observation of over 15,000 coronary artery bypass-grafting patients in the state of New York, and featured in the Journal of Health Services Research and Policy.
Coronary Artery Bypass-Grafting uses a cardiopulmonary bypass technique that externally circulates blood during surgery and thus allows the surgeon to conduct the operation in a blood-free setting. However, use of the cardiopulmonary bypass involves the risk of a stroke, renal failure, pulmonary dysfunction and cognitive deficits.
In contrast, the off-pump technique, which involves surgery on a beating heart without the assistance of a cardiopulmonary bypass, decreases the risk of such risks and therefore was reintroduced into the surgical arena in the late 1990’s.
Researchers found that out of the 15,313 off-pump coronary artery bypass artery surgical patients, 31 percent were black and 23 percent were white. The higher rates of off-pump techniques performed on black patients stemmed from surgeons who had less experience in performing the procedure. Researchers also found that the surgeons who have performed the off-pump procedure many times did not differentiate in the number of their black and white patients.
‘The data show that surgeons who perform fewer off-pump procedures are more likely to perform this new procedure on black patients, who may be less knowledgeable about treatment options and who are less likely to play an active role in choosing between alternative treatments,’ Mukamel said. ‘Whether this is intentional or unintentional, whether it can be explained by other factors, and whether this applies to other new technologies, need be the subject of further research and investigation. However, these findings need to be included as part of the ongoing discussions on the access of minorities to quality healthcare.’
The published article in the online Journal of Health Services Research and Policy highlights the development of the off-pump procedure for the coronary artery bypass-grafting surgery and the emerging need for surgeons to use this procedure instead of alternate, more risky techniques.