DOI: 10.1161/circ.148.suppl_1.13908 ISSN: 0009-7322

Abstract 13908: Racial Disparities in Surgical Approach for Patients With Atherosclerotic Chronic Limb Threatening Ischemia

William E Allen, Joshua D Greendyk, Syed F Haider, Afif Hossain, Abhishek Sharma
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Over 8 million individuals in the US have been diagnosed with peripheral artery disease (PAD) with a cumulative annual cost exceeding $21 billion dollars. Chronic limb-threatening ischemia (CLTI) is the most severe form of this group, with a 2-year mortality as high as 40%. This study aims to identify racial disparities in the different approaches to treatment of CLTI.

Methods: This IRB-approved retrospective study utilized data from the ACS-NSQIP. All recorded cases of surgical bypass, endovascular revascularization, or amputation below the knee for the treatment of CLTI between 2012 and 2021 were isolated. Propensity score matching and univariate analysis was performed to assess the independent effect of black self-identified race on access and outcomes.

Results: 50,184 cases of CLTI were identified. Using propensity and logistic regression, we identified that black self-reported race is an independent predictor of both endovascular revascularization and amputation rather than open bypass (OR = 1.542, 95% CI=1.451-1.639, p<.001; OR = 1.977, 95% CI=1.797-2.174, p<0.001). Additionally, black patients were significantly less likely to experience any postoperative complications (OR=0.928, CI=0.865-0.996, p=0.037).

Conclusion: Our analysis revealed a significant racial disparity in access to open bypass surgery. Our results also showed lower incidence of post-operative complications amongst CLTI black patients receiving endovascular revascularization or amputation. Our findings herein warrant further investigation to address racial disparities and barriers in the treatment of CLTI.

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