Self-identified Black Patients Experience Worse Outcomes After Carotid Endarterectomy And Lower Extremity Amputation: Racial Disparities Analysis
Syed F. Haider, MD1, Kasey L. Wood, BS2, Mario M. Matabele, BS2, Brian M. Leoce, BS1, Frank T. Padberg, MD1, Joe T. Huang, MD1, Michael A. Curi, MD1, Aziz M. Merchant, MD1, Saqib Zia, MD1.
1Rutgers New Jersey Medical School, Newark, NJ, USA, 2University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Objectives: Carotid Endarterectomy (CEA), Endovascular Aortic Aneurysm Repair (EVAR) and lower extremity amputations are three common vascular surgeries. Literature shows that African Americans are more likely to experience higher incidence of symptomatic carotid disease and have lower access to EVAR. Our study aims to investigate influence of race on the post-operative outcomes in these commonly performed surgeries.
Methods: The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database was queried from 2012-19, and all cases of EVAR, CEA and Below and Above Knee Amputations (BKA, AKA) were identified. Preoperative, operative, and postoperative variables were recorded and univariate analysis was performed. Propensity score matching algorithms were conducted to evaluate the effect of race on post-operative complications. Severe postoperative complications included sepsis, myocardial infarction, deep surgical site infection, pulmonary embolism, renal failure, stroke, and death. Minor postoperative complications include urinary tract infection, superficial surgical site infection, and pneumonia. Significance was achieved at p=0.05
Results: Database query isolated 79,726, 6,588 and 13,874 cases of CEA, EVAR and BKA/AKA, respectively. Propensity score matching of white versus black yielded 20,880 white and 4,176 black individuals that received CEA, 2,135 white and 427 black individuals that received EVAR and 7,426 white and 3,713 black individuals that received BKA or AKA. Analysis of the matched cohorts indicated that black individuals were more likely to experience any (p<0.001) and severe (p<0.001) complications after CEA and AKA or BKA than their white counterparts. There was no significant difference in post-operative complications between white and black individuals who have received EVAR.
Conclusion: Our analysis revealed that black patients experience significantly higher incidence of post-operative complications in CEA and leg amputations and no significant difference in the endovascular AAA repair. The findings herein warrant further investigation about why black patients experience worse outcomes post-operatively in CEA and Amputation to help reduce health care disparities.
| Carotid Endarterectomy | Endovascular AAA Repair | Below and Above the Knee Amputation | |||||||
| Postoperative Complication | White(N=20880)n (%) | Black(N=4176)n (%) | p-value | White(N=2135)n (%) | Black(N=427)n (%) | p-value | White(N=7426)n (%) | Black(N=3713)n (%) | p-value |
| Any | 2011 (9.6) | 533 (12.8) | <0.001 | 411 (19.3) | 95 (22.2) | 0.156 | 2670 (36.0) | 1499 (40.4) | <0.001 |
| Severe | 1626 (7.8) | 442 (10.6) | <0.001 | 358 (16.8) | 78 (18.3) | 0.452 | 2420 (32.6) | 1386 (37.3) | <0.001 |
| Minor | 834 (4.0) | 183 (4.4) | 0.830 | 118 (5.5) | 30 (7.0) | 0.226 | 831 (11.2) | 387 (10.4) | 0.221 |
| Reoperation | 499 (2.4) | 133 (3.2) | 0.371 | 101 (4.7) | 24 (5.6) | 0.436 | 525 (7.1) | 245 (6.6) | .355 |
| Readmission | 824 (3.9) | 180 (4.3) | 0.828 | 114 (5.3) | 30 (7.0) | 0.167 | 775 (10.4) | 368 (9.9) | 0.389 |
| Death | 176 (0.8) | 37 (0.9) | 0.465 | 58 (2.7) | 13 (3.0) | 0.706 | 312 (4.2) | 138 (3.7) | 0.221 |
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