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INTRODUCTION: Carotid occlusive disease is a major cause of stroke, accounting for 20-25% of cases in USA. Several studies have described a higher incidence of stroke and attributed mortality in minority ethnic groups. The Purpose of this study was to identify ethnic disparity in terms of risk profile, clinical presentation and outcome in patients undergoing carotid endartrectomy using national database.
METHODS: Using National Surgical Quality Improvement Program (NSQIP) data file from year 2005-2007, we identified patients undergoing carotid endartrectomy, CPT code (35301). Patients were divided into two groups based on ethnicity into white and non-white. Patients demographic, comorbidities, clinical presentation, post-operative morbidity and mortality were compared between groups using chi-square and t-test as appropriate.
RESULTS: Among 21,993 patients included in the study, 19,202 (87.3%) were white and 2,791 (12.7%) were non-white. Minority non-white group, were more likely to present with symptomatic carotid occlusive disease (7.5% vs. 4.8%, p<.001), procedure was done emergently (2.3% vs. 1.4%, p<.001), were younger (69.8 vs. 71.7, p<.001) and higher proportion of females (43.5 vs. 40.9%, p = .010), The non white group also had significantly higher cardiovascular risk factors including smoking, diabetes, coronary artery disease, history of coronary revascularization, COPD and end-stage renal disease (Table). Although there was no difference in postoperative MI, stroke, patients with non-white ethnicity had higher overall postoperative morbidity (5.3% vs. 4.0%, p = .001), mortality (1.2% vs. 0.06, p = .001) and total hospital duration (3.3 ± 6.9 vs. 2.3 ± 3.6, p<.001).
CONCLUSION: Review of the NSQIP database revealed ethnic minority group of patients presented with advance carotid occlusive disease at time of carotid surgery compared to the white population. This group also had higher postoperative morbidity and mortality and presented with higher number of cardiovascular risk factors. The findings may be due to delay in seeking treatment, limited access to care, and less rigorous screening . Further studies are required to identify factors delaying care for carotid occlusive disease in the non-white population.

	White N= 19202 (87.3%)	Non-White 2791 (12.7%)	P-value
Symptomatic disease	925 (4.8%)	208 (7.5%)	<.001
Emergency Case	264 (1.4%)	64 (2.3%)	<.001
Female Gender	7857 (86.6%)	1214 (13.4%)	0.01
Age	71.1 ± 9.3	69.8 ± 9.2	<.001
HTN	16366(85.2%)	2399 (86. %)	.330
MI	269 (1.4%)	45 (1.6%)	.395
Acute CHF in 30 days	150 (0.8%)	30 (1.1%)	.111
COPD	2078 (10.8%)	202 (7.2%)	<.001
IDDM	1651 (8.6%)	349 (12.5%)	<.001
NIDDM	3411 (17.8%)	632 (22.6%)	<.001
Smoker	5296 (27.6%)	826 (29.6%)	.028
PCI	3635 (18.9%)	462 (2.1%)	.003
CABG	4485 (23.4%)	561 (20.1%)	<.001
HTN	16366 (85.2%)	2399 (86%)	.330
ESRD	152 (0.8%)	53 (1.9%)	<.001
ASA III/Above	2381 (12.4%)	380 (13.6%)	.070
Postoperative variables
Stroke/CVA	296 (1.5%)	41 (1.5%)	.861
Coma > 24 hours	17 (0.1%)	6 (0.2%)	.062
MI	120 (0.6%)	16 (0.6%)	.885
SSI	42 (0.2%)	6 (0.2%)	1
Sepsis	85 (0.4%)	39 (1.4%)	<.001
Respiratory complications	316 (1.6%)	78 (2.8%)	<.001
Renal complication	37 (0.2%)	10 (0.4%)	.081
Morbidity	765 (4.0%)	148 (5.3%)	.001
Death	124 (0.6%)	34 (1.2%)	.001
Length of Surgery	114 ± 44	119 ± 46	<.001
Duration of Hospital stay	2.3 ± 3.6	3.3 ± 6.9	<.001