Racial Disparities in the Utilization and Outcomes of concomitant Left Atrial Appendage Exclusion during Cardiac Surgery: A Nationwide Analysis

Abstract

Background: Concomitant left atrial appendage exclusion (LAAE) during cardiac surgery is an effective method of reducing stroke risk in patients with atrial fibrillation. Previous studies have documented racial disparities in the performance of multiple cardiac procedures. We sought to evaluate if there were any disparities in the utilization and outcomes of concomitant LAAE. Methods: We used the 2016-2020 National Inpatient Sample database to identify hospitalizations for cardiac surgery in patients with atrial fibrillation with concomitant LAAE. We utilized the weighted data to compare the in-hospital mortality and complications such as stroke, bleeding, infection, heart failure and pericardial complications among different race/ethnic groups. Results: From 2016 to 2020, 432,244 hospitalizations were for cardiac surgery, of which 91,395 (21%) included concomitant LAAE. Of these, 77,440 (84.7%) were in White patients, 4,179 (4.6%) were in Black patients, 4,834 (5.3%) were in Hispanic patients, and 4,939 (5.4%) were in other races. Black and Hispanic patients had lower odds of undergoing concomitant LAAE during cardiac surgery compared to white patients (adjusted odds ratio (aOR) 0.85, 95% confidence interval (CI) 0.79-0.93 and aOR 0.85, 95% CI 0.79-0.93, respectively). There were no significant differences between Black and Hispanic patients in in?hospital mortality or procedural complications except for higher bleeding complications in Hispanic patients (aOR 2.38, 95% CI 1.27-2.86) compared to White patients. Through the study period, the proportion of patients receiving concomitant LAAE increased in all race/ethnic groups. Conclusion: Concomitant LAAE during cardiac surgery is underutilized in Black and Hispanic patients compared to White patients despite mostly similar clinical outcomes. Further comparative longitudinal studies are warranted to confirm these findings.