Navigation Links
Minorities have poorer results, higher rates of inappropriate surgery to prevent stroke
Date:8/25/2009

DALLAS Aug. 25, 2009 Minorities have poorer results and higher rates of unnecessary surgery from a common procedure used to remove plaque from inside the carotid artery, according to a UT Southwestern Medical Center doctor who is lead author of the study in the journal Stroke.

The multicenter study, available online and appearing in the July issue of the journal, found that higher rates of poor surgical outcomes for carotid endartectomy (CEA) a procedure performed to prevent stroke appeared to be due not only to elevated patient clinical risk in African-American and Hispanics, but also to the individual skill and experience of the doctor performing the operation.

"Identifying how various patient, physician and hospital-level factors may contribute to disparities has important implications for the design of clinical and health policy strategies for reducing them," said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.

"To my knowledge this is the first study to examine the stepwise impact of patient, surgeon and hospital factors as a way of understanding racial/ethnic disparities in clinically confirmed outcomes of carotid artery surgery," he said.

Previous research has demonstrated that minority groups in the U.S. have higher rates of heart attack and stroke. For example, African-Americans have greater numbers and higher severity of strokes, accompanied by higher rates of recurrence or death within 30 days.

Yet Hispanics have not been well-studied as a subgroup, Dr. Halm said.

The researchers used data from the New York Carotid Artery Surgery (NYCAS) study to examine the medical outcomes of 9,093 Medicare patients who had undergone carotid endartectomy in New York state. Of the patients, 95.3 percent were Caucasian, 2.5 percent were African-American and 2.2 percent were Hispanic.

They found that the minorities had much worse clinical outcomes. In the 30 days following surgery, 9.5 percent of the Hispanic patients and 6.9 percent of the African-Americans had died or suffered a stroke due to the procedure, compared with 3.8 percent of Caucasian patients. One reason minorities had higher complications rates was that they had severe neurological disease and more serious health conditions like heart disease and diabetes.

However, minorities were more likely to be cared for by less-experienced surgeons and hospitals. Adjusting for these patient and provider factors explained the worse results in African-Americans, but did not explain the poorer outcomes in Hispanics.

Rates of unnecessary surgery were also higher in minorities. For Hispanics, CEA was inappropriate in 17.6 percent of the cases; for African-Americans, 13 percent; and for Caucasians, 7.9 percent. The disparity in rates of unnecessary surgery was largely due to the higher burden of serious health conditions among minorities, which put them at much higher short-term risk of complications. If the short-term risk of carotid surgery is too high, the procedure is considered inappropriate.

"These results show we have the worst of all worlds," Dr. Halm said. "CEA is, paradoxically, both overused and underused in minorities and with worse results. More work is needed to help better understand the multiple factors that influence patient selection and surgical referral patterns. Developing evidence-based decision aids to help physicians and patients more accurately weigh the potential risks and benefits of CEA is one strategy we are pursuing to help improve this situation."


'/>"/>

Contact: Erin Prather Stafford
erin.pratherstafford@utsouthwestern.edu
214-648-3404
UT Southwestern Medical Center
Source:Eurekalert

Related medicine news :

1. AADE, Emory University and Johnson & Johnson Diabetes Institute Partner to Educate and Improve Access to Care for Atlanta-area Minorities with Diabetes
2. HIV Atlas Shows Virus Targeting Minorities
3. Study finds segregation decreases access to surgical care for minorities
4. U.S. Civil Rights Commission to Hold Public Briefing on Health Care Disparities Between Minorities and Non-Minorities, and Business Meeting
5. M. D. Anderson study predicts dramatic growth in cancer rates among US elderly, minorities
6. Minorities to Bear Brunt of Rise in U.S. Cancer Cases
7. Economic Bad Times Put Minorities at Higher Crime Risk
8. Minorities Distrust Medical System More
9. Building trust, increasing awareness among minorities
10. Terror Fears Tougher on Minorities, Disabled
11. Town Hall Meeting on Inequities in Clinical Trials Documents Ongoing Tuskegee Effect When Recruiting Minorities for Research Studies
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... 24, 2016 , ... Those who have experienced traumatic events may suffer from ... avenues, such as drug or alcohol abuse, as a coping mechanism. To avoid this ... coping following a traumatic event. , Trauma sufferers tend to feel a range of ...
(Date:6/24/2016)... ... June 24, 2016 , ... Dr. Amanda Cheng, ... treatment. Dr. Cheng has extensive experience with all areas of orthodontics, including robotic ... osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct to orthodontic treatment. It ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... proud to recognize Dr. Barry M. Weintraub as a prominent plastic surgeon and ... women in the world, and the most handsome men, look naturally attractive. Plastic ...
(Date:6/24/2016)... ... June 24, 2016 , ... Today, MTI-GlobalStem, a provider of ... other difficult to transfect cells, announces its launch of the PluriQ™ G9™ Gene ... System is a complete system for culturing and transfecting human pluripotent stem ...
(Date:6/24/2016)... ... June 24, 2016 , ... Today, InhaleLabs.com (Inhale) offilially launched its ... by matching users with high quality water pipes within an ideal price range. The ... Inhale was founded by two brothers, Nick and Mike Hunter, who use medical cannabis ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 , , , ... 7, 2016 , , , , LOCATION: , , , ... , , , EXPERT PANELISTS:  , , , Frost & Sullivan,s ... Christi Bird; Senior Industry Analyst, Divyaa Ravishankar and Unmesh Lal, Program ... global pharmaceutical industry is witnessing an exceptional era. Several new demand ...
(Date:6/23/2016)... 2016 The vast majority of dialysis patients ... Treatments are usually 3 times a week, with treatment ... travel time, equipment preparation and wait time.  This regimen ... for patients who are elderly and frail.  Many elderly ... rehabilitation centers for some duration of time. ...
(Date:6/23/2016)... 23, 2016 Leading BioSciences Inc., a ... conditions resulting from a breakdown of the mucosal ... Greg Doyle as chief executive officer. Mr. ... management team and board of directors, previously served ... He will provide continued leadership and strategic direction ...
Breaking Medicine Technology: