ABSTRACT
Background
There 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 methods
We 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.
Results
At 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).
Conclusions
There 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.
Keywords
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Article info
Publication history
Published online: August 14, 2021
Accepted:
July 12,
2021
Received in revised form:
June 18,
2021
Received:
March 3,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
