Racial Differences In Postoperative Lower Extremity Outcomes Among Veterans
Wayne Tse, MD, Cody Tragesser, MD, Kedar Lavinigia, MD, Michael Amendola, MD.
Central Virginia VA Medical Center, RICHMOND, VA, USA.
OBJECTIVES: Racial inequity has always been a part of and continues to grow in every facet of American life and institutions including the healthcare field. The Veteran Affairs System substantially differs from the standard American healthcare system due to the unified national healthcare. This study evaluates outcomes of individual undergoing non-traumatic lower extremity amputations based on race. METHODS: After obtaining IRB approval, VASQIP data was obtained for fiscal year 1998 to 2018. Cases were identified using CPT codes for lower extremity amputations. Pre-operative comorbidities and peri-operative variables were extracted from this database. Missing race data and unknown race were removed from the analysis. Data were analyzed with univariate analysis and forward stepwise logistic regression in SPSS (v27, IBM) to determine the risk factors for morbidity and mortality. RESULTS: A total of 44,389 patients met inclusion criteria. The average age was 66.5 years with 98.9% of the patients being male. The data categorized patients into six races: Hispanic White (n=2,638, 5.9%), Hispanic Black (n=217, 0.5%), American Indian or Alaskan Native (n=371, 0.8%), Black (n=12,572, 28.3%), Asian or Pacific Islander (n=98, 0.2%), or White (n=28,493, 64.2%). Most preoperative characteristics were statistically significant, notably, White veterans had fewer emergent cases (8.9% vs 9.6%, p>0.001) and more likely to have PAD with interventions (15.7% vs 16.5%, p>0.001). When comparing the most populous races, Black and White, the postoperative outcomes are not statistically significant. (Table I). After binary logistic regression, race has is mostly statistically nonsignificant in determining morbidity or mortality.
CONCLUSIONS: Lower extremity amputations among veterans have similar outcomes despite differences in preoperative comorbidities and race. These data are reassuring that the care provided to Veterans is not dependent on race. However, there appears to be room for improvement in management of preexisting comorbidities. Unfortunately, we were unable to determine other social and system factors that may contribute to differences in preoperative comorbidities.
| Postoperative Outcomes | Black (N=12,572) | White (N=28,493) | p-value |
| 30-day mortality | 1,405 (11.2) | 3,159 (11.1) | 0.792 |
| Any complication | 2,266 (18.0) | 5,392 (18.9) | 0.031 |
| Cardiac complication | 353 (2.8) | 736 (2.7) | 0.191 |
| Pulmonarycomplication | 666 (5.3) | 1,555 (5.5) | 0.509 |
| Renal complication | 191 (1.5) | 437 (1.5) | 0.912 |
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