1. Racial Disparities Associated With Reinterventions After Elective Endovascular Aortic Aneurysm Repair
- Author
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Vervoort, Dominique, Canner, Joseph K, Haut, Elliott R, Black, James H, Abularrage, Christopher J, Zarkowsky, Devin S, Iannuzzi, James C, and Hicks, Caitlin W
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Good Health and Well Being ,Aged ,Aortic Aneurysm ,Abdominal ,Blood Vessel Prosthesis Implantation ,Elective Surgical Procedures ,Endovascular Procedures ,Female ,Humans ,Medicare ,Retrospective Studies ,Risk Factors ,Treatment Outcome ,United States ,EVAR ,Vascular surgery ,Health services research ,Surgery ,Clinical sciences - Abstract
BackgroundThere are substantial racial and socioeconomic disparities underlying endovascular abdominal aortic aneurysm repair (EVAR) in the United States. To date, race-based variations in reinterventions following elective EVAR have not been studied. Here, we aim to examine racial disparities associated with reinterventions following elective EVAR in a real-world cohort.Materials and methodsWe used the Vascular Quality Initiative EVAR dataset to identify all patients undergoing elective EVAR between January 2009 and December 2018 in the United States. We compared the association of race with reinterventions after EVAR and all-cause mortality using Welch two-sample t-tests, multivariate logistic regression, and Cox proportional hazards analyses adjusting for baseline differences between groups.ResultsAt median follow-up of 1.1 ± 1.1 y (1.3 ± 1.4 y Black, 1.1 ± 1.1 y White; P = 0.02), a total of 1,164 of 42,481 patients (2.7%) underwent reintervention after elective EVAR, including 2.7% (n = 1,096) White versus 3.2% (n = 68) Black (P = 0.21). Black patients requiring reintervention were more frequently female, more frequently current or former smokers, and less frequently insured by Medicare/Medicaid (P < 0.05). After adjusting for baseline differences, the risk of reintervention after elective EVAR was significantly lower for Black versus White patients (HR 0.74, 95% CI 0.55-0.99; P = 0.04). All-cause mortality was comparable between groups (HR 0.81, 95% CI 0.33-2.00, P = 0.65).ConclusionsThere are significant differences between Black and White patients in the risk of reintervention after elective EVAR in the United States. The etiology of this difference deserves investigation.
- Published
- 2021