Variations in perioperative management and outcomes of patents undergoing coronary artery bypass grafting by sex, race, and ethnicity: analysis of a US cardiac surgery database.

BACKGROUND: Variations in coronary artery bypass graft (CABG) anaesthetic practices and their effects on clinical outcomes according to sex, race, and ethnicity are understudied.

METHODS: Patients who underwent isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2017 to December 2023 were included. Multivariable models evaluated (1) the association between key anaesthetic practices (transoesophageal echocardiography [TOE], pulmonary artery catheter [PAC], multimodal analgesia [MMA], acute normovolaemic haemodilution, transfusion algorithm, cerebral oximetry, electroencephalography, and anaesthesia care team) and sex, race, and ethnicity, and (2) the association between anaesthetic practices and postoperative morbidity and mortality.

RESULTS: In total, 40 009 patients were included. Female and Black patients were less likely to receive TOE when compared with male (odds ratio [OR] 0.86; P<0.001) and White patients (OR 0.78; 95% confidence interval [CI] 0.71-0.86; P<0.001). Black patients were less likely to receive PACs than White patients (OR 0.84; 95% CI 0.73-0.91; P<0.008). Female and Black patients were less likely to receive MMA when compared with male (OR 0.82; 95% CI 0.71-0.96; P=0.011) and White patients (OR 0.58; 95% CI 0.50-0.68; P<0.001). TOE (OR 0.88; 95% CI 0.78-1.00; P<0.047) and MMA (OR 0.76; 95% CI 0.65-0.88; P<0.001) were independently associated with improved outcomes. PAC (OR 1.25; 95% CI 1.15-1.36; P<0.001) and anaesthesia attending with fellow/resident team (OR 1.30; 95% CI 1.18-1.43; P<0.001) were independently associated with worse outcomes.

CONCLUSIONS: There is variability in CABG anaesthetic practices by sex, race, and ethnicity. Future studies should test whether adoption of specific anaesthetic practices in specific populations may impact CABG outcomes.