W. Alshwaily1, B. Nejim1, H. Dakour Aridi1, M. Rizwan1, S. Locham1, M. Malas1 1Johns Hopkins University School Of Medicine,Vascular Surgery/General Surgery,Baltimore, MD, USA
Introduction:
The impact of race and gender on surgical outcomes has been studied in infrainguinal revascularization procedures. However, it is yet to be investigated among the aortoiliac disease patients. The aim of this study is to explore how race and gender affect the outcomes in suprainguinal bypass (SIB) surgery.
Methods:
Patients who underwent SIB were identified from the procedure-targeted National Surgical Quality Improvement Program (NSQIP) dataset (2011-2015). Patients were stratified into four groups: non-black males(NBM), black males(BM), non-black females(NBF), and black females(BF). Primary outcomes were 30-day MACE (Major Adverse Cardiac Events a composite of MI, stroke, or death), postoperative bleeding requiring transfusion or intervention, major amputation, prolonged length of stay (pLOS>10days). Predictors of those outcomes were determined by multivariable logistic regression analysis adjusting for comorbidities, degree of limb ischemia, presentation, and elective vs. urgent repair.
Results:
Overall, 3700 patients were identified. Of which 54.6% were NBM, 5.7% BM, 35.2% NBF, and 4.6% BF. The event rates were 6.9%, 16.9% and 2.0% for MACE, bleeding and major amputation, respectively. BM were significantly younger [BM mean age: 62.8±10.8, NBM: 65.5±10.5, NBF: 66.8±12.2, BF: 64.1±12.6]. BM were more likely to be smokers, less likely to be on statin, and to receive elective SIB (NBM: 67.5%, BM:50.9%, NBF: 67.0%, BF: 58.7%) (all p≤.01). BF were more likely to be diabetic (NBM: 26.6%, BM: 24.3%, NBF: 24.1%, BF: 37.8%; p=.001), hypertensive, and functionally dependent (all p<.05). There were no significant differences in CHF and bleeding disorders in all groups. MACE outcomes were similar among all groups. BM had a threefold higher risk of limb loss [adjusted odds ratio (OR) (95%CI):3.23(1.38-7.59) p<.007] compared to other groups. While female gender was significantly associated with bleeding in both race groups, that association was more drastic in BF [OR(95%CI):2.57(1.65-4.01) p<.001] whereas NBF [OR(95%CI):1.61(1.27-2.04) p<0.001]. In comparison to other groups, BF had significant odds of pLOS [OR (95%CI):1.76(1.12-2.76) p<.014] (Figure).
Conclusion:
This is the largest study to date to demonstrate racial and gender disparity in SIB outcomes. BM had more than threefold increase of limb loss risk, and the risk of severe bleeding was more than doubled in BF. The advanced disease seen in younger patients, the comorbidity burden, and the emergent presentation might have contributed to this observed disparity, yet did not fully explain it. Race and gender consideration is warranted in risk assessment and refinement of patient selection for aortoiliac disease revascularization.
