PMID- 37051921
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231025
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 278
IP  - 5
DP  - 2023 Nov 1
TI  - Direct and Indirect Effects of Race and Socioeconomic Deprivation on Outcomes 
      After Lower Extremity Bypass.
PG  - e1128-e1134
LID - 10.1097/SLA.0000000000005857 [doi]
AB  - OBJECTIVE: To evaluate the potential pathway, through which race and 
      socioeconomic status, as measured by the social deprivation index (SDI), affect 
      outcomes after lower extremity bypass chronic limb-threatening ischemia (CLTI), a 
      marker for delayed presentation. BACKGROUND: Racial and socioeconomic disparities 
      persist in outcomes after lower extremity bypass; however, limited studies have 
      evaluated the role of disease severity as a mediator to potentially explain these 
      outcomes using clinical registry data. METHODS: We captured patients who 
      underwent lower extremity bypass using a statewide quality registry from 2015 to 
      2021. We used mediation analysis to assess the direct effects of race and high 
      values of SDI (fifth quintile) on our outcome measures: 30-day major adverse 
      cardiac event defined by new myocardial infarction, transient ischemic 
      attack/stroke, or death, and 30-day and 1-year surgical site infection (SSI), 
      amputation and bypass graft occlusion. RESULTS: A total of 7077 patients 
      underwent a lower extremity bypass procedure. Black patients had a higher 
      prevalence of CLTI (80.63% vs 66.37%, P < 0.001). In mediation analysis, there 
      were significant indirect effects where Black patients were more likely to 
      present with CLTI, and thus had increased odds of 30-day amputation [odds ratio 
      (OR): 1.11, 95% CI: 1.068-1.153], 1-year amputation (OR: 1.083, 95% CI: 
      1.045-1.123) and SSI (OR: 1.052, 95% CI: 1.016-1.089). There were significant 
      indirect effects where patients in the fifth quintile for SDI were more likely to 
      present with CLTI and thus had increased odds of 30-day amputation (OR: 1.065, 
      95% CI: 1.034-1.098) and SSI (OR: 1.026, 95% CI: 1.006-1.046), and 1-year 
      amputation (OR: 1.068, 95% CI: 1.036-1.101) and SSI (OR: 1.026, 95% CI: 
      1.006-1.046). CONCLUSIONS: Black patients and socioeconomically disadvantaged 
      patients tended to present with a more advanced disease, CLTI, which in mediation 
      analysis was associated with increased odds of amputation and other complications 
      after lower extremity bypass compared with White patients and those that were not 
      socioeconomically disadvantaged.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Powell, Chloe A
AU  - Powell CA
AUID- ORCID: 0000-0003-2963-2813
AD  - Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann 
      Arbor, MI.
FAU - Albright, Jeremy
AU  - Albright J
AD  - Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor 
      MI.
FAU - Culver, Jacob
AU  - Culver J
AD  - Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI.
FAU - Osborne, Nicholas H
AU  - Osborne NH
AD  - Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann 
      Arbor, MI.
FAU - Corriere, Matthew A
AU  - Corriere MA
AD  - Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann 
      Arbor, MI.
FAU - Sukul, Devraj
AU  - Sukul D
AD  - Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor 
      MI.
FAU - Gurm, Hitinder
AU  - Gurm H
AD  - Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor 
      MI.
FAU - Henke, Peter K
AU  - Henke PK
AD  - Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann 
      Arbor, MI.
LA  - eng
PT  - Journal Article
DEP - 20230413
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Humans
MH  - Risk Factors
MH  - *Peripheral Arterial Disease/surgery
MH  - Treatment Outcome
MH  - Limb Salvage
MH  - Ischemia/surgery
MH  - Lower Extremity/surgery
MH  - Socioeconomic Factors
MH  - Retrospective Studies
COIS- C.A.P. is supported by training grant AG062043 from the National Institute on 
      Aging. P.K.H. and D.S. receive salary support from the Blue Cross Blue Shield of 
      Michigan. Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) is 
      a regional quality collaborative supported by Blue Cross and Blue Shield of 
      Michigan. The remaining authors report no conflicts of interest.
EDAT- 2023/04/14 06:00
MHDA- 2023/10/23 12:41
CRDT- 2023/04/13 05:04
PHST- 2023/10/23 12:41 [medline]
PHST- 2023/04/14 06:00 [pubmed]
PHST- 2023/04/13 05:04 [entrez]
AID - 00000658-202311000-00061 [pii]
AID - 10.1097/SLA.0000000000005857 [doi]
PST - ppublish
SO  - Ann Surg. 2023 Nov 1;278(5):e1128-e1134. doi: 10.1097/SLA.0000000000005857. Epub 
      2023 Apr 13.