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Certain racial disparities exist after AAA repair
While perioperative mortality was similar across races among patients undergoing repair of an intact abdominal aortic aneurysm, black patients had an elevated rate of postoperative renal failure and Asian patients, despite higher long-term survival, had an elevated rate of postoperative MI, according to a new analysis.
The researchers analyzed 21,961 patients (94% white, 5.2% black, 1.4% Asian) who underwent open or endovascular intact AAA repair between 2003 and 2017 and were included in the Vascular Quality Initiative. Endpoints of interest were various in-hospital outcomes and late survival.
Compared with white and Asian patients, black patients were more likely to be symptomatic (black, 16%; white, 9.1%; Asian, 11%; P < .001) and to have endovascular aneurysm repair instead of open surgery (black, 87%; white, 83%; Asian, 84%; P < .001), Sarah E. Deery, MD, MPH, from the division of vascular and endovascular surgery at Beth Israel Deaconess Hospital, Boston, and the department of surgery at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.
Thirty-day mortality did not differ by race after EVAR (black, 1.1%; white, 1.1%, Asian, 0.8%; P = .8) or open repair (black, 4.3%; white, 2.6%; Asian, 1.9%; P = .33), according to the researchers.
New postoperative dialysis occurred more frequently in black patients (black, 1.6%; white, 0.8%; Asian, 0.7%; P = .01), as did return to the operating room (black, 4.3%; white, 2.9%; Asian, 0.9%; P < .01), Deery and colleagues wrote.
Mean length of stay was longer in black patients after EVAR (black, 3.3 days; white, 2.6 days; Asian, 2.6 days; P < .001) and in Asian and black patients after open repair (black, 10.5 days; white, 8.5 days; Asian, 13 days; P < .001), wrote.
After adjustment for age, sex, smoking, CAD, congestive HF, chronic obstructive pulmonary disease, preoperative dialysis, diabetes, hospital volume, repair type, urgency of repair and aortic diameter, compared with white patients, black patients were more likely to require postoperative dialysis (OR = 2.2; 95% CI, 1.3-3.6) and to return to the operating room (OR = 1.6; 95% CI, 1.2-2.2).
At 5 years, survival was 92% for Asian patients vs. 84% for black patients and 85% for white patients (HR for Asian patients = 0.6; 95% CI, 0.4-0.97), despite Asian patients having greater odds of postoperative MI than white patients (OR = 4; 95% CI, 2.3-7).
“Further research is warranted to understand the mechanism of these disparities to provide excellent quality care to patients of all backgrounds,” Deery and colleagues wrote. – by Erik Swain
Disclosure: Deery reports no relevant financial disclosures. One author reports he consults for Endologix and receives grants from Cook Medical and Medtronic.