F. C. Patel1, M. D. Giglia1, A. Gullick1, M. S. Morris1, B. J. Pearce1, D. I. Chu1 1University of Alabama Birmingham,Department Of Surgery,Birmingham, ALABAMA, USA
Introduction: Racial disparities in surgical outcomes, such as readmissions, have been demonstrated in minority populations. Few studies have examined disparities in length-of-stay (LOS) for vascular procedures. We aim to investigate the role of race in determining LOS for patients undergoing lower extremity revascularization (LER) using a national, surgical outcomes registry.
Methods: We queried the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify all patients who underwent elective LER and stratified patients by approach (open versus endovascular) and race. Patients were excluded if they had any in-hospital, post-operative complications during their index admission or a 30-day mortality. Chi-square and Wilcoxon Rank Sums tests were used to determine the differences among categorical and continuous variables, respectively. The primary model outcome was total post-operative LOS. Predictors of LOS were identified with multivariate regression using a negative binomial model.
Results: Of 6,843 patients who underwent lower extremity revascularization, 76.2% and 23.8% of patients underwent an open or endovascular approach, respectively. Black patients represented 16.3% of the overall cohort, with women representing 47.5% and 34.3% of black and white patients, respectively. Black and white patients were similar with respect to BMI (27.4 vs. 27.3), ASA class distribution, and functional health. Compared to white patients, black patients were younger (65 vs. 74 years, p<0.05) and had significantly higher rates of smoking, hypertension, dialysis, insulin-dependent diabetes, and steroid use (p<0.05). On adjusted comparison, black patients who underwent an open LER experienced a longer post-operative LOS (4 vs. 3 days, p<0.001) compared to white patients. With an endovascular approach, no significant difference in LOS existed between races (1 vs. 1 day, p>0.05).
Conclusion: Black patients undergoing open LER have a significantly longer LOS in comparison to white patients even with no in-hospital complications. No racial disparities in LOS were observed for patients undergoing LER by endovascular approach. Further investigations will need to examine non-NSQIP elements such as psychosocial, behavioral, and educational factors that may explain disparities in open LER.