Racial Disparities in the Management of Ruptured Abdominal Aortic Aneurysms

JOURNAL OF VASCULAR SURGERY Volume 61, Number 6S

Abstracts 77S

was additionally predictive of postoperative myocardial infarction (OR, 2.9 [1.4-6.0]). Conclusions: Careful deliberation of the operative risks and the necessity of the additional interventions are therefore advised during operative planning for open AAA treatment. This study also highlights the importance of avoiding thrombosis perioperatively. Author Disclosures: K. H. Ultee: Nothing to disclose; S. L. Zettervall: Nothing to disclose; D. B. Buck: Nothing to disclose; J. J. Siracuse: Nothing to disclose; P. A. Soden: Nothing to disclose; J. D. Darling: Nothing to disclose; H. J. Verhagen: Nothing to disclose; M. L. Schermerhorn: Cordis, Endologix, Cook, consulting fee. Racial Disparities in the Management of Ruptured Abdominal Aortic Aneurysms Tian Nini Zhang1, Anahita Dua2, James Pan1, Douglas Hood3, Kim J. Hodgson1, Sapan S. Desai1. 1Southern Illinois University, Springfield, Ill; 2Medical College of Wisconsin, Milwaukee, Wisc; 3USC, Los Angeles, Calif Objectives: We sought to quantify the impact of racial disparities and clinical outcomes in patients with abdominal aortic aneurysms (AAAs) who undergo endovascular aneurysm repair (EVAR) or open aneurysm repair (OAR). Methods: A retrospective analysis was completed using the Nationwide Inpatient Sample (NIS), identifying clinical records between 2000 and 2011 using the International Classification of Diseases-9th Revision diagnosis and procedure codes for patients who developed a ruptured abdominal aortic aneurysm and subsequently underwent OAR or EVAR. Univariate tests of association were completed using c2 for categoric variables, the Mann-Whitney U test for continuous variables, and multiple logistic regression analysis to determine predictors of complications and outcomes. Matched cohorts of patients were created using logistic regression models to develop a propensity score predicting the likelihood of death. Predictor variables included patient demographics and comorbidities. For both OAR and EVAR, one Caucasian patient was matched with one African American patient who underwent surgery for ruptured AAA to reduce the effects of selection bias. Results: African Americans had a higher length of stay (14.3 vs 12.9 days, P < .001), and higher hospital cost ($64,628 vs $61,039, P ¼ N.S.), but a lower inpatient mortality (36.8% vs 42.5%, P < .001). For matched

cohorts, inpatient mortality was still lower for African Americans than their Caucasian counterparts (19.8% vs 27.6%, P < .001). The overall rate of postoperative complications is generally lower for African Americans who undergo either OAR or EVAR for ruptured AAA. Postoperative infections are 8.33 times higher in Caucasians than African Americans for OAR (2.5% vs .3%, P < .05), but 4.85 times higher in African Americans than Caucasians following EVAR (6.3% vs 1.3%, P < .001). Based upon the results of a Mann-Kendall trend analysis, there is a statistically significant decline in mortality for Caucasians (s ¼ e0.041, P < .001) and African Americans (s ¼ e0.125, P < .01) who undergo OAR or EVAR (s ¼ e0.103, P < .01). Conclusions: African American patients have a higher likelihood of having serious comorbidities such as hypertension, peripheral arterial disease, and end-stage renal disease, making them poorer AAA candidates for OAR. However, African Americans as a population still have statistically lower inpatient mortality compared with Caucasians after OAR. Despite African Americans having a higher rate of complications than Caucasians after EVAR for a ruptured AAA, they also still have a lower overall mortality rate. Overall, mortality rates for Caucasians and African Americans have been decreasing from 2000 to 2011 after both OAR and EVAR of ruptured AAA. African Americans who have a ruptured AAA have a clear survival advantage over Caucasian patients. This result does not appear to be due to differences in comorbidities, age, or gender. Differences in transfer times, income status, or hospital covariates could contribute to the differences seen in survival advantage. Author Disclosures: T. N. Zhang: Nothing to disclose; A. Dua: Nothing to disclose; J. Pan: Nothing to disclose; D. Hood: Nothing to disclose; K. J. Hodgson: Lombardi Medical, consulting fee; S. S. Desai: Nothing to disclose. Outcomes of Dialysis Access for Pregnant Women With ESRD Elena Stuewe1, Sarah Koch2, Anahita Dua3, James Pan2, Douglas Hood4, Kim J. Hodgson2, Sapan S. Desai2. 1 Southern Illinois University, Carbondale, Ill; 2Southern Illinois University, Springfield, Ill; 3Medical College of Wisconsin, Milwaukee, Wisc; 4USC, Los Angeles, Calif Objectives: The prevalence of end-stage renal disease (ESRD) in pregnant women is low, thereby complicating

Table. Prevalence of major vascular disease during pregnancy, outcomes, and incidence of interventions Prevalence (per 100,000 pregnancies)

Preeclampsia/ eclampsia

Abortion

Maternal death

Cerebrovascular accident Abdominal aortic aneurysm

0.80 0.42

4.6% 18.0%a

0.0% 0.0%

10.0%a 0.0%

Ruptured abdominal aortic aneurysm

0.036

0.0%

0.0%

100%a

Variable

End-stage renal disease

15.24

3.9%

5.4%a

1.8%a

Peripheral artery disease

2.00

6.6%a

1.6%b

0.0%

0.85

b

0.0%

0.0%

Takayasu disease

EVAR, Endovascular aneurysm repair. a P < .01. b P < .05 compared with cohort of unaffected pregnant women.

8.8%

Intervention

Incidence of intervention

Carotid endarterectomy EVAR Open aneurysm repair EVAR Open aneurysm repair Arteriovenous fistula or graft Dialysis catheter Angioplasty and stent Peripheral bypass N/A

0 0 0 0 0 2.3% 18.0% 0.8% 0 0