Study Finds Black Patients Face Higher Risk of Cardiovascular Complications After Surgery

Many patients recover well after surgery, but some face severe complications in the weeks that follow. Postoperative complications aren’t random — they can reflect deeper inequities in the healthcare system that need to be addressed.

A new analysis of about 3.8 million patients undergoing non-cardiac surgery found significant racial disparities in severe cardiovascular complications after surgery. Black patients face higher risks of serious complications, even after adjusting for health and surgical factors. This research underscores the need for better interventions during postoperative care to improve health outcomes for Black patients.

Study Overview: Cardiovascular Complications After Surgery

The retrospective cohort analysis, published in the Journal of Racial and Ethnic Disparities, sourced data from the American College of Surgeons National Surgical Quality Improvement Program (NSIP) between 2018 and 2022. Researchers analyzed data from nearly 3.8 million adult patients 18 and older undergoing inpatient non-cardiac surgeries. 

Thirty days post-surgery, the most prevalent complication was major adverse cardiac, cerebral, and thrombotic event (MACE), including myocardial infarction, cardiac arrest, stroke, pulmonary embolism, deep vein thrombosis (DVT), or death. Among patients, the overall MACE incidence was 1.95 percent. 

MACE rates varied by race and ethnicity, with Black patients having greater complications (2.11 percent), followed by non-Hispanic white patients (2.01 percent), and Hispanic patients (1.27 percent).

This research adds to long-standing evidence showing that Black patients continue to have poorer postoperative outcomes following non-cardiac surgery, while non-Hispanic white patients have lower rates.

Researchers noted that while this dataset highlights disparities in care, it lacks a deeper examination of the social determinants of health (SDOH), such as acculturation, that can contribute to higher incidence rates among certain racial and ethnic groups.

Why These Disparities Exist

Even after adjusting for age, comorbidities, and the type of surgery, researchers discovered that the disparities continued to persist for Black patients. 

Ultimately, the likely contributors to these disparities in cardiovascular complications include:

• Access to care: Black patients may experience differences in the quality of hospital care they receive, as well as delayed treatment or referrals to specialized care.
• Pre-existing health inequities: The Black community faces a higher burden of chronic conditions, such as high blood pressure and diabetes, which are often linked to structural inequities, not biological factors.
• Systemic and structural factors: Black patients continue to face implicit biases from healthcare professionals, as well as varied postoperative monitoring and follow-up. Additionally, SDOH, such as housing, income, and health insurance, influence the quality of care they receive post-surgery.

What Clinicians and Healthcare Systems Can Do

Providers and the healthcare system as a whole must discover new ways to better serve Black patients during postoperative care to improve their outcomes.

Some effective strategies to consider include:

• Improving equity in surgical care: Healthcare systems can implement improved risk-stratification tools that account for disparities and create standardized postoperative care pathways to better support patients.
• Strengthening follow-up care: Providers can deliver more aggressive monitoring for patients at high risk of developing heart-related complications post-surgery.
• Addressing bias and systems-level gaps: Healthcare systems should require implicit bias training and re-education for providers, diversify the healthcare workforce, and invest more in underserved communities.

These approaches won’t lead to significant changes overnight, but they are the right steps towards delivering more effective postoperative care to reduce life-threatening complications for Black patients.

The Bigger Picture

While this study focuses on postsurgical care, racial disparities are seen across all areas of medicine. Minority populations — especially the Black community — continue to face often long-standing inequities in receiving high-quality and culturally sensitive care in the healthcare system. In combination with socioeconomic factors, this community continues to experience poorer health outcomes stemming from structural barriers rather than from individual behavior alone. 

Why This Research Matters Now

This large dataset of nearly 4 million patients strengthens credibility by reconfirming disparities like these persist despite the many advancements in modern medicine. Underserved communities will continue to face inequities that impact their health outcomes without an urgent call for policy and clinical changes across the board. 

The Takeaway

New research shows that Black patients remain at a higher risk for serious cardiovascular complications after surgery. It underscores the need for more awareness and changes at the systemic level to improve outcomes for Black patients, who are already disproportionately affected by cardiovascular conditions. Closing these gaps in postoperative care outcomes will require a coordinated approach from providers, healthcare systems, and policymakers. It’s important to remember that these disparities are not patient-level failures. They reflect system-level problems that require system-level solutions.

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