PMID- 35149160
OWN - NLM
STAT- MEDLINE
DCOM- 20220524
LR  - 20221207
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 75
IP  - 6
DP  - 2022 Jun
TI  - Contemporary outcomes of limb-salvage procedures using Vascular Quality 
      Initiative-Medicare-linked data: Racial and ethnic disparities persist.
PG  - 2013-2018
LID - S0741-5214(22)00236-1 [pii]
LID - 10.1016/j.jvs.2022.01.120 [doi]
AB  - BACKGROUND: Several reports have shown that ethnic and racial minority patients 
      with chronic limb-threatening ischemia (CLTI) are more likely to undergo major 
      amputation. Whether this disparity is driven by limited access to care, 
      statistical discrimination, or biologic factors has remained a matter of debate. 
      We studied the effects of race and ethnicity on the short- and long-term outcomes 
      of limb-salvage procedures among patients with new-onset CLTI. METHODS: We 
      identified all patients who had undergone first time (open or endovascular) 
      revascularization for CLTI between January 2010 and December 2016 in the Vascular 
      Quality Initiative-Medicare-linked database. These patients were divided into two 
      groups: non-Hispanic White (NHW) and racial and ethnic minority (REM). The early 
      end points included length of stay and operative mortality. The 2-year outcomes 
      included major amputation, freedom from subsequent revascularization, number of 
      limb salvage reinterventions, and all-cause mortality. Subanalyses comparing NHW 
      and Hispanic patients and NHW and Black patients were also performed. RESULTS: Of 
      16,249 patients presenting with CLTI, 73.9% were NHW. The REM patients were 
      younger (mean age, 69.9 +/- 11.3 years vs 74.2 +/- 10.5 years; P < .001) and more 
      likely to be women (45.9% vs 37.7%; P < .001). Other baseline differences 
      included a higher rate of smoking history, coronary artery disease, chronic 
      obstructive pulmonary disease, and chronic kidney disease for the NHW group. In 
      contrast, the REM patients were more likely to have diabetes and hypertension and 
      were more likely to present with tissue loss (78% vs 76.6%; P = .04). The 
      preoperative ankle brachial index and procedure type (endovascular vs open) were 
      similar between the two groups. On multivariable analysis, the NHW group had had 
      a 13% increase in the length of stay and a 25% decrease in operative mortality. 
      Of the 2-year outcomes, the limb salvage estimate was 86% for the NHW group and 
      77.1% for the REM group (P < .001). A comparison between the two groups showed 
      similar rates of freedom from subsequent revascularization (67.9% vs 67.1%; 
      P =.2). The REM patients had had higher rates of overall survival (70.3% vs 
      68.4%; P = .01) compared with their NHW counterparts. The patients in the REM 
      group were also more likely to have undergone more than two limb salvage 
      reinterventions during follow-up (14.2% vs 8.6%; P < .001). After adjusting for 
      potential confounders, the REM patients had significantly greater odds of major 
      amputation at 2 years (adjusted hazard ratio, 1.49; 95% confidence interval, 
      1.36-1.63; P < .001). CONCLUSIONS: The results from the present Vascular Quality 
      Initiative-Medicare-matched study have shown that REM patients continue to face a 
      higher major amputation risk despite equivalent attempts at limb salvage. Further 
      studies to identify the risk factors and evaluate intervention strategies that 
      might be more effective in preventing amputation in this particular population 
      are warranted.
CI  - Published by Elsevier Inc.
FAU - Mathlouthi, Asma
AU  - Mathlouthi A
AD  - Division of Vascular and Endovascular Surgery, University of California, San 
      Diego, La Jolla, Calif.
FAU - Zarrintan, Sina
AU  - Zarrintan S
AD  - Division of Vascular and Endovascular Surgery, University of California, San 
      Diego, La Jolla, Calif.
FAU - Khan, Maryam-Ali
AU  - Khan MA
AD  - Division of Vascular and Endovascular Surgery, University of California, San 
      Diego, La Jolla, Calif.
FAU - Malas, Mahmoud
AU  - Malas M
AD  - Division of Vascular and Endovascular Surgery, University of California, San 
      Diego, La Jolla, Calif.
FAU - Barleben, Andrew
AU  - Barleben A
AD  - Division of Vascular and Endovascular Surgery, University of California, San 
      Diego, La Jolla, Calif. Electronic address: abarleben@health.ucsd.edu.
LA  - eng
PT  - Journal Article
DEP - 20220208
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - *Endovascular Procedures/adverse effects
MH  - Ethnicity
MH  - Female
MH  - Humans
MH  - Ischemia/diagnosis/surgery
MH  - Limb Salvage
MH  - Male
MH  - Medicare
MH  - Middle Aged
MH  - Minority Groups
MH  - *Peripheral Arterial Disease/diagnosis/surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - United States
OTO - NOTNLM
OT  - Bypass
OT  - Chronic limb-threatening ischemia
OT  - Ethnic disparity
OT  - Peripheral arterial disease
OT  - Peripheral vascular intervention
OT  - Racial disparity
EDAT- 2022/02/13 06:00
MHDA- 2022/05/25 06:00
CRDT- 2022/02/12 05:29
PHST- 2021/06/04 00:00 [received]
PHST- 2022/01/21 00:00 [accepted]
PHST- 2022/02/13 06:00 [pubmed]
PHST- 2022/05/25 06:00 [medline]
PHST- 2022/02/12 05:29 [entrez]
AID - S0741-5214(22)00236-1 [pii]
AID - 10.1016/j.jvs.2022.01.120 [doi]
PST - ppublish
SO  - J Vasc Surg. 2022 Jun;75(6):2013-2018. doi: 10.1016/j.jvs.2022.01.120. Epub 2022 
      Feb 8.