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Racial Disparities Associated With Reinterventions After Elective Endovascular Aortic Aneurysm Repair

  • Dominique Vervoort
    Affiliations
    Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Joseph K. Canner
    Affiliations
    Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Elliott R. Haut
    Affiliations
    Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

    Division of Acute Care Surgery, Department of Surgery; Department of Anesthesiology and Critical Care Medicine; Department of Emergency Medicine; The Johns Hopkins University School of Medicine, Baltimore, Maryland

    The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
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  • James H. Black
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Christopher J. Abularrage
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Devin S. Zarkowsky
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, University of Colorado School of Medicine, Aurora, Colorado
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  • James C. Iannuzzi
    Affiliations
    Division of Vascular and Endovascular Surgery, University of California, San Francisco, California
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  • Caitlin W. Hicks
    Correspondence
    Corresponding author. Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, 600 N Wolfe St, Halsted 668, Baltimore, MD 21287-8611,Tel.410-955-5165; fax 410-367-2462.
    Affiliations
    Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Division of Vascular and Endovascular Surgery, University of California, San Francisco, California
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Published:August 14, 2021DOI:https://doi.org/10.1016/j.jss.2021.07.010

      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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