Race Based Outcomes After Abdominal Aortic Aneurysm Repair; An Analysis Using the National Surgical Quality Improvement Program (NSQIP) Database
Xavier Pereira, MD, Afshin Parsikia, MD, Amit Shah, MD, Melvin Stone, MD, McNelis John, MD, Rivera G. Aksim, MD.
Jacobi Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA.
OBJECTIVE: Surgical repair is the standard of care for patients with abdominal aortic aneurysms (AAA) that meet certain, widely documented criteria. However, like with other interventions in vascular surgery, we continue to see disparities in access and surgical outcomes in non-white patients undergoing AAA repair. These differences have been attributed to both patient-related and access-related factors. We used the NSQIP database to describe surgical outcomes between ethnic groups undergoing AAA repair.
METHODS: This is a retrospective review of all patients undergoing AAA repair entered into the NSQIP database between 2012-2015. NSQIP outcomes were compared between groups while controlling for baseline characteristics. We categorized race and ethnicity as follows: White-Non-Hispanics (W-NH), Black-Non-Hispanics (B-NH), Hispanics, and Other. The odds ratio of the accompanied procedures and outcomes were compared with the W-NH group as the reference group.
RESULTS: During the study period, 7793 patients underwent repair of AAA, comprising of 7017 (90%) W-NH , 425 B-NH (5.5%), 132 Hispanic (1.7%), and 219 Other (2.8%). There was a significant difference in operative time (P < 0.001), length of stay (P = 0.007), rates of lower extremity ischemia in open cases (P < 0.001), and rate of hypogastric embolization in endovascular aneurysm repair (EVAR) cases (P < 0.001) between W-NH and ethnic minority patients. On multivariate analysis, both B-NH (OR 2.231, P < 0.01) and Hispanic (OR 1.714, P = 0.043) required a higher rate of hypogastric artery embolization in EVAR cases. Additionally, B-NH had a higher overall mortality (OR 0.478, P = 0.017) while Hispanics were more likely to have an operative time great than 150 minutes (OR 1.534, P = 0.003) and length of stay greater than two days (OR 1.424, P= 0.022) when compared to W-NH.
CONCLUSIONS: Our study highlights the inferior outcomes of ethnic minorities undergoing AAA repair. We hypothesize that driving this disparity are inadequate screening and delayed presentation. This may explain the higher mortality seen in blacks and the longer length of stay in Hispanics. Longer operative times, higher rates of lower extremity ischemia, and increased hypogastric embolization highlight the increased complexity of treating advanced disease. Future studies are needed to evaluate the adequacy of screening ethnic minorities and the challenges faced in accessing care once diagnosed.
Back to 2019 ePosters