Racial disparities in treatment of ruptured abdominal aortic aneurysms |
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| Affiliation: | 1. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA;2. Division of Cardiothoracic and Vascular Surgery, Howard University Hospital, Washington, DC;3. Division of Vascular and Endovascular Surgery, Warren Alpert Medical School of Brown Surgical Associates, Providence, RI;4. Division of Vascular and Endovascular Surgery, University of Washington, Seattle, WA;1. Department of Surgery, University of Michigan, Ann Arbor, MI;2. Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI;3. Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI;4. Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI;5. Vascular Surgery, Beaumont Health, Farmington Hills, MI;6. Department of Surgical Disciplines, Central Michigan University, Saginaw, MI;7. Vascular Surgery, McLaren Bay Heart & Vascular, Bay City, MI;1. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA;2. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA;3. Department of Vascular Surgery, Bernhoven Hospital, Uden, Netherlands;4. Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands;5. Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands;6. Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI;7. Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA;8. Department of Vascular Surgery, Hôpitaux Robert Schuman – Hopital Kirchberg, Luxembourg, MN;9. Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN;10. Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA;11. Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL;12. Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX;13. Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD;14. Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI;15. Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX;p. Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;q. Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO;r. Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia;s. Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany;t. Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy;u. Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO;v. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT;w. Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary;x. Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy;y. Division of Vascular and Endovascular Surgery, Department of Surgery, McLaren Health System, Bay City, MI;1. Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;2. Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;3. Department of Surgery, University of California at San Francisco, San Francisco, CA;1. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass;2. Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands;3. Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI;4. Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash;1. Division of Vascular Surgery and Endovascular Therapy, Loyola University Health System, Maywood, IL;2. Department of Surgery, Loyola University Medical Center, Maywood, IL;3. Stritch School of Medicine, Loyola University Chicago, Maywood, IL |
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| Abstract: | ObjectiveThe Society for Vascular Surgery has recommended immediate transfer of patients with ruptured abdominal aortic aneurysms (rAAAs) to a regional center when feasible. However, Black patients might be less likely to be transferred and more likely to be turned down for repair. We, therefore, examined the transfer rates, turndown rates, and outcomes for Black vs White patients presenting with rAAAs in two large databases.MethodsWe examined all rAAA repairs in the Vascular Quality Initiative from 2003 to 2020 to evaluate the transfer rates and outcomes for Black vs White patients. We used the National Inpatient Sample from 2004 to 2015 to examine the turndown rates. Mixed effects logistic regression, Cox regression, and marginal effects modeling were used to study the interaction between race, insurance status, surgery type (open repair vs endovascular aortic aneurysm repair), and hospital volume.ResultsWe identified 4935 patients with rAAAs in the Vascular Quality Initiative (6.2% Black) and 48,489 in the National Inpatient Sample (6.0% Black). The rates of transfer were high; however, Black patients were significantly less likely to undergo transfer before repair compared with White patients (49% Black vs 62% White; P = .002). The result was consistent in both crude and adjusted analyses when considering only stable patients and was not modified by insurance status, surgery type, or hospital volume. No significant differences were found in perioperative mortality (22% vs 26%; P = .098) or complications (52% vs 52%; P = .64). However, Black patients were significantly more likely to be turned down for repair (37% vs 28%; odds ratio, 1.5; 95% confidence interval, 1.2-1.9; P < .001). A significant interaction was found between race and insurance status with respect to turndown. Patients with private insurance had undergone surgery at a similar rate, regardless of race. However, among patients with Medicare or Medicaid/self-pay, Black patients were less likely than were White patients to undergo repair (Medicare, 64% vs 72%; P = .001; Medicaid/self-pay, 43% vs 61%; P = .031). Patients with Medicaid/self-pay were also less likely to undergo repair than were patients of the same race with either Medicare or private insurance (P < .05).ConclusionsWe found that Black patients with rAAAs are poorly served by the current systems of interhospital transfer in the United States, because they less often undergo transfer before repair. Although the postoperative outcomes appeared similar, this finding could be falsely optimistic, because Black patients, especially the underinsured, were turned down for repair more often even after adjustment. Significant work is needed to better understand the reasons underlying these disparities and identify the targets to improve the care of Black patients with rAAAs. |
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| Keywords: | Abdominal aortic aneurysm Disparities Racial disparities Ruptured abdominal aortic aneurysm Rupture Turndown |
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