Racial Disparities In Clinical Characteristics And Outcome Of Endovascular Aortic Aneurysm Repair: An Analysis From Targeted EVAR PUF In ACA NSQIP
Lifen Cao, MD PhD, Gregory Simonian, MD, David J. O'Connor, MD, FACS.
Hackensack University Medical Center, Hackensack, NJ, USA.
OBJECTIVES: We aimed to explore the racial disparities in clinical characteristics and outcomes of Endovascular Aortic Aneurysm Repair (EVAR) among different races. METHODS: The Targeted Endovascular Aneurysm Repair (EVAR) Participant Use Data File (PUF) and the main American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult PUF database were analyzed. Chi-square analysis was used to compared the clinical characteristics and outcome between patients with different ethnicities. Multivariable logistic regression determined the association between race and ICU stay. RESULTS: Among the 13,873 EVAR procedures performed between 2013 to 2018, 10,562 (76.13%) were white, 853 (6.15%) were black or African Americans, 262 (1.89%) were Asian, 2196 (15.83%) were un-identified. Asians presented at an older age with 50.76% above age 75 years old, followed by whites with 42.12% above 75 years old. No differences in aneurysm diameters or prior abdominal aortic surgery histories occurred among different races. More whites had bilateral groin cutdown for the EVAR access (43.61%), while more Asians had percutaneous bilateral accesses (54.83%, P<0.001). African Americans and Asians were more likely to have hypogastric revascularizations (8.56%, 7.25% vs. 5.3% in white, respectively. P<0.001), iliac branched device (23.68%, 19.85% vs. 16.18% in white, respectively. P<0.001), iliac stent (18.05%, 19.47% vs. 14.72% in whites, respectively. P=0.004). Asians or other were more likely to be put in an aortic stent (11.45% vs. 7.5% in black and 7.12% in white, P=0.027). No differences on access vessels (conduit or repair, P=0.550), the renal stent placement(P=0.200), incidence of acute conversion to open procedure (p =0.681), ischemia colitis(p=0.323), lower extremity ischemia (p=0.182), rupture of aneurysm (p=0.410) and 30-day mortality (P=0.671). However, African Americans and Asians had longer ICU courses than whites (26.03%, 22.18% vs. 17.06% for ICU stay above 2 days, respectively. P<0.001). Non-white race contributed to longer ICU stays even after controlling demographics and comorbidities: odds ratio of 0.56 (P<0.001) for African American and 0.54 for Asian or (P=0.002) compared with whites. CONCLUSIONS: Among the EVAR patients, Asians and whites presented at an older age than African Americans, but there is no difference in post-EVAR aneurysm rupture or 30-day mortality among different races. African Americans and Asians, however, were associated with longer ICU stays.
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