African Americans who undergo the most frequently performed blood vessel operation, carotid endarterectomy (CEA), have worse outcomes than whites, according to a new study by Johns Hopkins researchers. The study, reported in the November issue of Annals of Surgery, blames the discrepancy, in part, on the fact that African Americans tend to be operated on by less experienced surgeons than whites.
"In Maryland, at least, African Americans undergoing elective CEA do not do as well as whites because their care is more likely to be delivered in hospitals where fewer CEAs are performed and by surgeons who are less experienced," says Bruce Perler, M.D., professor of surgery at Johns Hopkins. "We believe this situation may be linked to socioeconomic and health insurance status."
For the study, Hopkins investigators reviewed the Maryland Health Services Cost Review Commission database to identify all elective CEA procedures performed in all non-federal acute care hospitals in Maryland from 1990 to 1995. They then examined the influence of race and other factors on the rates of in-hospital mortality, in-hospital stroke, length of stay and total hospital charges.
Although African Americans have been known for years to experience a higher stroke rate and stroke death rate than whites, and although carotid endarterectomy has been proven in multiple studies to be an effective stroke-preventing operation, the researchers found that African Americans made up only 6 percent of the CEA procedures. Only 623 African Americans underwent the operation in the study period, compared to 9,219 whites.
The researchers found that the in-hospital stroke rate was 3.1 percent among African Americans and 1.6 percent among white patients. Although African American race was an independent risk factor for in-hospital stroke, they also discovered that patients operated on by surgeons who performed a high volume of procedures were less likely to have a stroke during surgery, and
Contact: Kate O'Rourke
Johns Hopkins Medical Institutions