L. Stewart1, A. Beck1, E. Spangler1 1University Of Alabama at Birmingham,Department Of Surgery, Division Of Vascular Surgery And Endovascular Therapy,Birmingham, Alabama, USA
Introduction: Vein conduit for infrainguinal bypass (IB) has better patency than prosthetic conduits. We explore if racial disparities exist in use of vein conduit for IB, and examine associations of patient factors and systems of care factors with racial disparities in conduit use.
Methods: We analyzed a retrospective cohort of 23,959 IBs originating from the common femoral artery performed for occlusive disease with non-missing race/ethnicity in the SVS Vascular Quality Initiative (VQI) from 2003-17. Demographics of patients receiving vein vs other conduit were compared by t test and X2 testing, while univariate and multivariate logistic regression analyses were performed to evaluate for predictors of vein conduit use, with the pseudo-R2 used as an assessment of the model.
Results:Lower proportions were found in vein bypass patients of women, minorities, emergent cases, patients with ASA class>3, prior CABG, prior IB or ipsilateral IB, dialysis, or COPD. A higher proportion of vein bypass patients had vein mapping, distal target below the knee, or diabetes.
Unadjusted regression of vein use by race showed black patients were 88% as likely (p<.001), Hispanic patients 90% as likely (p=.08), and non-white/non-black/non-Hispanic patients 93% as likely (p=.37) to have a vein IB compared to white patients; however race alone explains only 0.04% of variation in vein conduit use. Adjusted models after backward stepwise regression demonstrated black patients were 76% as likely (p<.001), Hispanic patients 79% as likely (p=.003), and non-white/non-black/non-Hispanic patients 83% as likely (p=.09) to have a vein IB compared to white patients; however other factors had greater weight within the model. Factors most correlating with vein use included vein mapping and more distal target. Factors most strongly against vein use included higher age, ASA class 4, bedridden mobility status pre-op, any prior CABG, prior ipsilateral IB, or bypass performed before 2012; however the entire adjusted model still explained only 15% of variation in vein conduit use. Due to the importance of vein mapping, we examined the racial breakdown of vein mapping by target level (Figure) and saw that while black patients were less likely to receive vein IB, they were vein mapped at similar or higher rates than other groups.
Conclusion: Racial disparities exist in conduit use for IB from the common femoral artery for occlusive disease, with blacks less likely to receive vein bypasses, however the contribution of race to conduit selection is small in adjusted and unadjusted models. Overall, pre-operative variables captured in the VQI poorly predicted vein conduit use for IB.
