The impact of race and insurance type on the outcome of endovascular abdominal aortic aneurysm (AAA) repair.
BACKGROUND
Although mortality and complication rates for abdominal aortic aneurysm (AAA) have declined over the last 20 years, operative complication rates and perioperative mortality are still high, specifically for repair of ruptures. The goal of this study was to determine the influence of insurance type and ethnicity while controlling for the influences of potential confounders on procedure selection and outcome following endovascular AAA repair (EVAR).


METHODS
Using the Nationwide Inpatient Sample (NIS) database, we identified patients who underwent EVAR repair of ruptured and elective infrarenal AAA, between 1990 and 2003. Insurance type and ethnicity were analyzed against the primary outcome variables of mortality and major complications. The potential confounders of age, gender, operative location, diabetes, and Deyo index of comorbidities, were controlled.


RESULTS
Bivariate analyses demonstrated significant differences between insurance types and ethnicity and mortality and complications. Patients who were self pay had adverse outcomes in comparison to Private insurance. Whites encountered less perioperative mortality and postoperative complications than Blacks and Hispanics.


CONCLUSIONS
After controlling for previously identified associative factors for AAA outcome, ethnicity and insurance type does influence EVAR surgical outcome. Subsequent studies that break down emergent repair vs elective surgery and that longitudinally stratify delay in surgery, or time to admission may be useful.
Lemaire
Anthony
A
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Cook
Chad
C
Tackett
Sean
S
Mendes
Donna M
DM
Shortell
Cynthia K
CK
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data