Philip P. Goodney1, Benjamin S. Brooke1, Jessica B. Wallaert1, Lori L. Travis3, Frances L. Lucas3, David A. Goodman2, Jack L. Cronenwett1, David H. Stone1
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; 3Center for Outcomes Research and Evaluation (CORE), Portland, ME.
OBJECTIVES: Racial 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 TAA, via open surgery or 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% black), and 2,732 patients who underwent TEVAR (8% black). In open repair, black patients had higher 30-day mortality than white patients (18% vs. 10%, p<0.001), while mortality rates were similar with TEVAR (8% black vs. 9% white, p=0.56). For open repair, black patients were more likely to undergo surgery at low vol. hospitals than high vol. hospitals (28% vs. 18%, p<0.001, Figure), and overall operative mortality was highest in low vol. hospitals (14% vs. 7%, p<0.001). However, for TEVAR, black patients were not more likely to undergo repair at low vol. hospitals, and no mortality differences were evident by volume (Figure, p=NS). Multivariable analyses confirmed that black race was associated with increased mortality for open surgery (OR=2.0, 95% CI1.5-2.5, p<0.001), but not TEVAR (OR=0.9, 95% CI=0.6-1.5, p=0.72).
CONCLUSIONS: While racial disparities in surgical care have a significant effect on mortality with open TAA repair, black patients undergoing TEVAR obtain similar outcomes as white patients. New technology can limit the effect of racial disparities in vascular care.
AUTHOR DISCLOSURES: B. S. Brooke, Nothing to disclose; J. L. Cronenwett, Nothing to disclose; D. A. Goodman, Nothing to disclose; P. P. Goodney, NIH and SVS grants, Research Grants; F. L. Lucas, Nothing to disclose; D. H. Stone, Nothing to disclose; L. L. Travis, Nothing to disclose; J. B. Wallaert, Nothing to disclose.
Posted April 2012