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Eliminating Racial Disparities After Infrainguinal Bypass Surgery
Isibor Arhuidese, MD MPH, Caitlin Hicks, MD MS, Tammam Obeid, MD, Karen Massada, MD MS, Besma Nejim, MD MPH, Thomas Reifsnyder, MD, Mahmoud Malas, MD MHS.
Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Introduction: Prior reports suggest a treatment bias towards use of non-autogenous grafts in African Americans (AA) due the assumption that these patients do not have good veins. This disparity results in worse outcomes for AA’s. In this adequately powered study, we investigate racial disparities in a contemporary cohort of patients who underwent open infrainguinal bypass surgery (OBS).
Methods: A retrospective cohort study of all patients who underwent OBS between January 1st 2007 and July 31st 2014 in a tertiary teaching hospital. Kaplan-Meier and Cox regression were employed to evaluate outcomes that were defined and analyzed per SVS criteria.
Results: There were 428 autogenous grafts placed in 368 patients. Of these, 312 (73%) bypasses were placed in Caucasians, 100 (23%) in African Americans (AA) and 16 (4%) in patients who identified as other races. AA patients were more likely to be female (65 vs 35%; p<0.001), diabetic (74 vs 57%; p<0.05); have renal disease (53% vs 34%; p<0.05) and be on dialysis (22 vs 10%; p<0.05) compared to Caucasians. The majority of patients presented with critical limb ischemia (AA: 80%, Caucasian: 79%; p=0.3). There was no significant difference in limb salvage rates between the two groups (AA: 83% vs Caucasians: 90%; p=0.1). There was also no significant difference in the graft patency comparing AA to Caucasians (table 1, fig1&2). The significant predictors of loss of patency were diabetes mellitus and hyperlipidemia (p<0.05).
Conclusion: Using our contemporary cohort of patients, we have shown that despite having more severe comorbidities and several other predictors of worse outcomes, there were no differences in patency or limb salvage between AA and Caucasians after OBS utilizing autogenous conduits. We believe that outcomes of racial minorities can be optimized with use of autogenous conduits, comprehensive multidisciplinary perioperative care, meticulous follow up and treatment of comorbidities.  
Graft patency comparing African Americans to Causcasians: Multivariate cox regression | Caucasians | African Americans | | | Outcome | Ref | HR (95% CI) | P-value | | Primary patency | 1 | 0.90 (0.65-1.25) | 0.54 | | Primary assisted patency | 1 | 1.12 (0.79-1.59) | 0.53 | | Secondary patency | 1 | 1.34 (0.84-2.15) | 0.22 |
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