Racial disparity in early graft failure after infrainguinal bypass.
BACKGROUND
Racial disparities have been shown to be associated with increasing health-care costs. We sought to identify racial disparities in 30-d graft failure rates after infrainguinal bypass in an effort to define targets for improved health care among minorities.


METHODS
The 2005-2011 National Surgical Quality Improvement Program database was queried for patients with peripheral arterial disease who underwent infrainguinal bypass as their primary procedure. A bivariate analysis was done to assess pre and intraoperative risk factors across race (whites, blacks, and Hispanics). Multivariate logistic regression was performed to assess the independent association of race with 30-d graft failure.


RESULTS
Of a total of 16,276 patients, 12,536 (77.0%) were whites, 2940 (18.1%) blacks, and 800 (4.9%) Hispanics. Black patients were more likely to be younger, female, current smokers, and on dialysis (P<0.001, all). In addition, whites were less likely to present with critical limb ischemia compared with blacks and Hispanics (44.2 versus 55.4 versus 52.8%, respectively; P<0.001). Similarly, fewer whites underwent femoral-tibial (31.4 vs. 34.7 vs. 38.6% respectively) or popliteal-tibial level bypasses (8.9 versus 13.4 versus 16.1%, respectively) than blacks and Hispanics (P<0.001, all). There was no difference in the use of autogenous conduit across the groups (P=0.266). Proportionally more blacks than whites developed early graft failure (6.7 versus 4.5%; P<0.001) but there was no difference comparing Hispanics to whites (6.0 versus 4.5%; P=0.057). On multivariable analysis, black race remained independently associated with early graft failure (adjusted odds ratio=1.26, 95% confidence interval 1.05-1.51; P=0.011).


CONCLUSIONS
More blacks and Hispanics present with critical limb ischemia, requiring distal revascularization. Even when controlling for anatomic differences and degree of peripheral arterial disease, black race remained independently associated with early graft failure after infrainguinal bypass. These results identify a target for improved outcomes.
Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University School of Medicine, Baltimore, Maryland.
Shalini
S
Selvarajah
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
James H
JH
Black
Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Adil H
AH
Haider
Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: cabular1@jhmi.edu.
Christopher J
CJ
Abularrage
D000328:Adult; D000368:Aged; D044383:Black People; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000208:ethnology / Q000601:surgery*; D011183:Postoperative Complications / Q000208:ethnology*; D044465:White People
Complications; Early graft failure; Infrainguinal bypass; NSQIP; Racial disparity