PMID- 35768062 OWN - NLM STAT- MEDLINE DCOM- 20221025 LR - 20231102 IS - 1097-6809 (Electronic) IS - 0741-5214 (Print) IS - 0741-5214 (Linking) VI - 76 IP - 5 DP - 2022 Nov TI - Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia. PG - 1335-1346.e7 LID - S0741-5214(22)01748-7 [pii] LID - 10.1016/j.jvs.2022.06.026 [doi] AB - OBJECTIVE: Black and Hispanic patients have had higher rates of chronic limb-threatening ischemia (CLTI) and experienced worse perioperative outcomes after lower extremity bypass compared with White patients. The underlying reasons for these disparities have remained unclear, and data on 3-year outcomes are limited. Therefore, we examined the differences in 3-year outcomes after open infrainguinal bypass for CLTI stratified by race/ethnicity and explored the potential factors contributing to these differences. METHODS: We identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Our primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. We also recorded the 30-day major adverse limb events (MALE) defined as major amputation or reintervention. We used Kaplan-Meier estimation methods and multivariable Cox regression analyses to evaluate the outcomes stratified by race/ethnicity and identify contributing factors. RESULTS: Of the 7108 patients with CLTI, 5599 (79%) were non-Hispanic White, 1053 (15%) were Black, 48 (1%) were Asian, and 408 (6%) were Hispanic patients. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%; hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.7-2.2), reintervention (Black vs White, 61% vs 57%; HR, 1.2; 95% CI, 1.1-1.3), and 30-day MALE (Black vs White, 8.1% vs 4.9%; HR, 1.3; 95% CI, 1.2-1.4) but lower mortality (Black vs White, 38% vs 42%; HR, 0.9; 95% CI, 0.8-0.99). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%; HR, 1.6; 95% CI, 1.3-2.0), reintervention (Hispanic vs White, 70% vs 57%; HR, 1.4; 95% CI, 1.2-1.6), and MALE (Hispanic vs White, 8.7% vs 4.9%; HR, 1.5; 95% CI, 1.3-1.7. However, mortality was similar between the two groups (Hispanic vs White, 38% vs 42%; HR, 0.88; 95% CI, 0.76-1.0). The low number of Asian patients prevented a meaningful assessment of amputation (Asian vs White, 20% vs 19%; HR, 0.93; 95% CI, 0.44-2.0), reintervention (Asian vs White, 55% vs 57%; HR, 0.79; 95% CI, 0.51-1.2), MALE (Asian vs White, 8.5% vs 4.9%; HR, 0.71; 95% CI, 0.46-1.1), or mortality (Asian vs White, 36% vs 42%; HR, 0.83; 95% CI, 0.52-1.3). In the adjusted analyses, the association of Black race and Hispanic ethnicity with amputation and reintervention was explained by differences in the demographic characteristics (ie, age, sex) and baseline comorbidities (ie, tobacco use, diabetes, renal disease). CONCLUSIONS: Compared with White patients, Black and Hispanic patients had higher 3-year major amputation and reintervention rates. However, mortality was lower for Black patients than for the White patients and similar between Hispanic and White patients. Disparities in amputation and reintervention were partly attributable to differences in demographic characteristics and the higher prevalence of comorbidities in Black and Hispanic patients with CLTI. Future work is necessary to determine whether interventions to improve access to care and reduce the burden of comorbidities in these populations will confer limb salvage benefits. CI - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Anjorin, Aderike C AU - Anjorin AC AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Marcaccio, Christina L AU - Marcaccio CL AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Patel, Priya B AU - Patel PB AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Wang, Sophie X AU - Wang SX AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Rowe, Vincent AU - Rowe V AD - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA. FAU - Aulivola, Bernadette AU - Aulivola B AD - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, IL. FAU - Wyers, Mark C AU - Wyers MC AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Schermerhorn, Marc L AU - Schermerhorn ML AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: mscherm@bidmc.harvard.edu. LA - eng GR - F32 HS027285/HS/AHRQ HHS/United States GR - T32 HL007734/HL/NHLBI NIH HHS/United States GR - T35 HL110843/HL/NHLBI NIH HHS/United States GR - U01 FD006936/FD/FDA HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. DEP - 20220626 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Humans MH - Aged MH - United States MH - *Peripheral Arterial Disease MH - Ischemia MH - Ethnicity MH - Chronic Limb-Threatening Ischemia MH - Risk Factors MH - Treatment Outcome MH - Chi-Square Distribution MH - Medicare MH - Limb Salvage MH - Amputation, Surgical MH - Retrospective Studies MH - *Endovascular Procedures/adverse effects PMC - PMC9613538 MID - NIHMS1819300 OTO - NOTNLM OT - Chronic limb-threatening ischemia OT - Ethnicity OT - Limb salvage OT - Race OT - Revascularization COIS- CONFLICTS OF INTEREST: None reported EDAT- 2022/06/30 06:00 MHDA- 2022/10/26 06:00 PMCR- 2023/11/01 CRDT- 2022/06/29 19:23 PHST- 2022/03/28 00:00 [received] PHST- 2022/06/11 00:00 [revised] PHST- 2022/06/21 00:00 [accepted] PHST- 2022/06/30 06:00 [pubmed] PHST- 2022/10/26 06:00 [medline] PHST- 2022/06/29 19:23 [entrez] PHST- 2023/11/01 00:00 [pmc-release] AID - S0741-5214(22)01748-7 [pii] AID - 10.1016/j.jvs.2022.06.026 [doi] PST - ppublish SO - J Vasc Surg. 2022 Nov;76(5):1335-1346.e7. doi: 10.1016/j.jvs.2022.06.026. Epub 2022 Jun 26.