title: Thoracic endovascular aneurysm repair, race, and volume in thoracic aneurysm repair.
abstract: BACKGROUND
  Volume-based 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 TAAs, via open surgery or thoracic endovascular aneurysm repair (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% of whom were black) and 2732 patients who underwent TEVAR (8% of whom were black). In open repair, black patients had higher 30-day mortality than white patients (18% vs 10%; P<.001), while mortality rates were similar with TEVAR (8% black vs 9% white; P=.56). For open repair, black patients were more likely to undergo surgery at low-volume hospitals, where overall operative mortality was highest (14% at very low-volume hospitals, 7% at very high-volume hospitals; P<.001). However, for TEVAR, black patients were not more likely to undergo repair at low-volume hospitals, and mortality differences were not evident across volume strata (9% at very low-volume hospitals, 7% at very high-volume hospitals; P=.328). Multivariable analyses adjusting for age, sex, race, comorbidity, and volume confirmed that increased perioperative mortality was associated with black race for open surgery (OR, 2.0, 95% CI, 1.5-2.5; P<.001) but not TEVAR (OR, 0.9, 95% CI, 0.6-1.5; P=.721).
  
  
  CONCLUSIONS
  While racial disparities in surgical care have a significant effect on mortality with open thoracoabdominal aortic aneurysm repair, black patients undergoing TEVAR obtain similar outcomes as white patients. New technology can limit the effect of racial disparities in surgical care.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA. philip.goodney@hitchcock.org
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: Jessica
authors.initials: J
authors.lastname: Wallaert
authors.forename: Lori
authors.initials: L
authors.lastname: Travis
authors.forename: F Lee
authors.initials: FL
authors.lastname: Lucas
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.forename: David H
authors.initials: DH
authors.lastname: Stone
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D017052:Hospital Mortality / Q000208:ethnology; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000208:ethnology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*