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Trends in the Utilization and Mortality for Coronary Artery Bypass Graft (CABG) Surgery in California Hospitals

CABG utilization in California decreased from 2009 to 2021. There were 62.2 CABG surgeries per 100,000 adult population in 2009 compared to 48.2 CABG surgeries per 100,000 adult population in 2021.

CABG surgery, a major interventional procedure to treat coronary artery diseases, is the most common type of open-heart surgery and the costliest procedure in California. Other studies have shown large disparities in the use of CABG procedures and outcomes by sex and race/ethnicity.*

This report evaluates the changes in CABG utilization and outcomes in California by assigned sex at birth and race/ethnicity over time and is important in the evaluation of hospital resources, regional health policy, quality improvement, and the promotion of health equity.

Key Findings

  • Males compared with females had higher CABG utilization, but the percent of declines over time in females (35.9 percent) was much greater than males (17.3 percent).
  • CABG utilization decreased in all age subgroups over time. Adults 65 to 84 years of age had the highest CABG utilization, however ≥85 years of age had the highest decline rate (65.3 percent) compared with 65 to 84 years of age (39.5 percent), 45 to 64 years of age (19.1 percent) and 18 to 44 years of age (24.7 percent).
  • CABG utilization decreased in all race/ethnicity subgroups. Non-Hispanic (NH) White had the highest CABG utilization. NH Black had the highest decline rate (28.5 percent) compared with NH white (24.3 percent), and Hispanic (9.4 percent).
  • CABG utilization increased for NH American Indian / Alaskan Native (17.6 percent) and NH Asian / Pacific Islander (8.1 percent) subgroups over the 12-year period.
  • The statewide rate for in-hospital mortality was stable over time with the highest mortality in 2020. This trend was consistent among all subgroups.
  • During 2009-2021, the mortality rate remained higher in females compared with males, with the difference growing wider over time.
  • Adults 85 years of age and older had the highest in-hospital mortality rate, followed by 65 to 84 years of age, 18 to 44 years of age and 45 to 64 years of age.
  • Although in-hospital mortality rates for NH Blacks varied by year, likely due to low numbers, they are often higher than rates for other race/ethnic groups.
View Underlying Data

How HCAI Created this Product

This product was created based on CABG surgery clinical data collected by the California Cardiovascular Outcomes Reporting Program (CCORP) from 2009 to 2021. Clinical CABG data were linked to Patient Discharge Data and California State death records.

Utilization rates by assigned sex at birth, age, and race/ethnicity were calculated using Single-Race Population Estimates by State from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER). The data were updated annually by the National Center for Health Statistics.

*References:

  • Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, Geirsson A, Desai NR, Krumholz HM. Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014. J Am Heart Assoc. 2018:118.009014.
  • Dani SS, Minhas AMK, Arshad A, Krupica T, Goel SS, Virani SS, Sharma G, Blankstein R, Blaha MJ, Al-Kindi SJ, Nasir K, Khan SU. Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018. J Am Heart Assoc. 2021;121:021361.

Additional Information

Topic: Healthcare Quality
Source Link: Healthcare Utilization Data, Coronary Artery Bypass Graft Reports
Citation: HCAI – Healthcare Utilization; Patient-Level Administrative Data; Trends in the Utilization and Outcome of Coronary Artery Bypass Grafting in California Hospitals
Temporal Coverage: 2009-2021
Spatial/Geographic Coverage: Statewide
Frequency: Annual