R. Chowdhury1,2,3, W. Jiang1, C. K. Zogg1, E. B. Schneider1,2, A. H. Haider1,2 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Harvard School Of Medicine,Surgery,Brookline, MA, USA 3Harvard School Of Public Health,Boston, MA, USA
Introduction: Patient race has been associated with length of stay (LOS) after Coronary Artery Bypass Graft (CABG) surgery in hospital-based claims data. Previous reports have included patients with a wide variety of payer types. We sought to test the hypothesis that Black vs. White race-based differences in LOS would not exist among patients who have medical coverage as a result of their affiliation with the United States Armed Forces using the Tricare database which contains individuals eligible for the Tricare insurance program. We examined this hypothesis comparing findings among patients treated at military hospitals and those treated at civilian facilities.
Methods: Using Tricare data, which include uniformed service personnel, dependents and retirees, we identified patients aged 18-65 years without Medicare coverage who underwent their first reported CABG (ICD-9CM 36.10 -36.20) between 2006-2010. Patients with concurrent valve surgeries or who had length of stay < 1 day or >30 days were excluded. Patient demographics were compared between Black and White patients using standard descriptive methods, stratified by gender. Linear regression models examined Black vs. White differences in patient LOS, controlling for patient and hospital-level factors. Analyses were conducted among patients treated in military facilities and, separately, among patients receiving care in civilian hospitals.
Results:Of the 3247 CABG patients, 2884 (89%) were White, of whom 9.9% were female. Among Black patients, 78 (21.5%) were female. Most patients were retirees or their dependants (86.8%). 30% of White and 33% of Black patients underwent emergent CABG (p=0.23). In gender stratified adjusted analyses, Black males experienced greater LOS vs. White male patients (7.8 vs. 7.2 days respectively, p=0.02); however, there was no difference in LOS between Black vs. White females (p=0.12). On subset analysis, race-based difference in LOS among males was observed only in civilian hospitals (8.2 vs. 7.3 days, p=0.004); there was no difference in LOS between Black and White male patients treated in military hospitals (p=0.37). Among female patients, LOS did not differ by race between military and civilian hospitals. Older age and emergent CABG were associated with longer stay for both male and female patients across both races and facility types.
Conclusion:In this cohort of younger adult CABG patients insured through military affiliation, Black race was associated with greater LOS among male, but not female, patients. This race-based variability in LOS was associated with care in civilian facilities. Factors underlying this race-based difference in LOS, present only in civilian hospitals, should be elucidated.
