Thoracic endovascular aneurysm repair, race, and volume in thoracic aneurysm repair

J Vasc Surg. 2013 Jan;57(1):56-63, 63.e1. doi: 10.1016/j.jvs.2012.07.036. Epub 2012 Nov 22.

Abstract

Background: Volume-based disparities in surgical care are often associated with poorer results in African American patients. We examined the effect of treatment patterns and outcomes, by race, for isolated thoracic aortic aneurysm (TAA).

Methods: Using Medicare claims (1999-2007), we studied all patients undergoing repair of TAAs, via open surgery or thoracic endovascular aneurysm repair (TEVAR). We studied 30-day mortality and complications by race, procedure type, and hospital volume.

Results: We studied 12,573 patients who underwent open TAA repair (4% of whom were black) and 2732 patients who underwent TEVAR (8% of whom were black). In open repair, black patients had higher 30-day mortality than white patients (18% vs 10%; P<.001), while mortality rates were similar with TEVAR (8% black vs 9% white; P=.56). For open repair, black patients were more likely to undergo surgery at low-volume hospitals, where overall operative mortality was highest (14% at very low-volume hospitals, 7% at very high-volume hospitals; P<.001). However, for TEVAR, black patients were not more likely to undergo repair at low-volume hospitals, and mortality differences were not evident across volume strata (9% at very low-volume hospitals, 7% at very high-volume hospitals; P=.328). Multivariable analyses adjusting for age, sex, race, comorbidity, and volume confirmed that increased perioperative mortality was associated with black race for open surgery (OR, 2.0, 95% CI, 1.5-2.5; P<.001) but not TEVAR (OR, 0.9, 95% CI, 0.6-1.5; P=.721).

Conclusions: While racial disparities in surgical care have a significant effect on mortality with open thoracoabdominal aortic aneurysm repair, black patients undergoing TEVAR obtain similar outcomes as white patients. New technology can limit the effect of racial disparities in surgical care.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Thoracic / ethnology
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Chi-Square Distribution
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / mortality
  • Endovascular Procedures / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Healthcare Disparities / ethnology*
  • Hospital Mortality / ethnology
  • Hospitals, High-Volume / statistics & numerical data*
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Medicare / statistics & numerical data
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Complications / ethnology
  • Postoperative Complications / mortality
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology