Disparities in 180-day infection rates following coronary artery bypass grafting and aortic valve replacement

Abstract

Objective

The study objective was to compare sex and racial differences in 180-day infection rates after coronary artery bypass grafting and aortic valve replacement.

Methods

A statewide Society of Thoracic Surgeons Adult Cardiac Surgery Database was linked to Medicare claims data to identify 8887 beneficiaries undergoing coronary artery bypass grafting and aortic valve replacement (surgical or transcatheter) between 2017 and 2021. The primary outcome was the incidence of 180-day infection. Secondary outcomes included 10 infection subtypes. Multivariable logistic regression was used to evaluate the relationship between sex and race (Black vs non-Black) and infections. Two secondary analyses were conducted: (1) robustness of the primary analysis after excluding urinary tract infections given established sex-related differences and (2) testing a sex∗race interaction.

Results

The mean (SD) age of the cohort was 74.5 (8.9) years, with 36.9% female and 4.2% Black. The infection rate was 19.6%, although this varied by patient sex (female vs male: 23.7% vs 17.1%) and race (Black vs non-Black: 28.0% vs 19.2%), both P less than .0001. Differences in infection rates for female patients were driven by urinary tract infections and pneumonia for Black patients. Risk-adjusted odds of infection were 1.6-fold significantly higher among female patients but nonsignificant for Black patients. A sex∗race interaction was present, with non-Black female patients versus non-Black male patients having a 1.63 higher odds of infection.

Conclusions

This multicenter study identified a 1.6-fold higher odds of infection among female patients. Non-Black female versus male patients had a 63% higher odds of infection. Transdisciplinary collaborative learning interventions should be considered to address these known disparities in infection rates.