J Vasc Surg. 2020 Dec 2:S0741-5214(20)32499-X. doi: 10.1016/j.jvs.2020.10.087. Online ahead of print.
INTRODUCTION: Racial disparities in open thoracic aortic aneurysm repair have been well documented, with black patients reported to suffer from poor outcomes compared with their white counterparts. It is unclear whether these disparities extend to the less invasive thoracic endovascular aortic repair (TEVAR). This study aims to examine the clinical characteristics, perioperative outcomes, and one-year survival of black versus white patients undergoing TEVAR in a national vascular surgery database.
METHODS: The Vascular Quality Initiative database was retrospectively queried to identify all patients who underwent TEVAR between January 2011 and December 2019. The primary outcomes were 30-day mortality and one-year survival after TEVAR. Secondary outcomes included various types of major postoperative complications. Multivariable logistic regression analyses were performed to identify predictors of 30-day mortality and perioperative complications. Multivariable Cox regression analysis was used to determine the predictors of one-year survival.
RESULTS: A total of 2669 patients with TEVAR were identified in the VQI, of whom 648 were black patients (24.3%). Compared to white patients, black patients were younger and associated with a higher burden of comorbidities, including hypertension, diabetes, congestive heart failure, dialysis-dependent, and anemia. Black patients were more likely to be symptomatic, present with aortic dissection, and undergo urgent or emergent repair. There was no statistically significant difference in 30-day mortality between black and white patients (3.4% vs. 4.9%, p = 0.1). After adjustment for demographics, comorbidities, and operative factors, black patients were independently associated with a 56% reduction in 30-day mortality risk compared with their white counterparts (OR = 0.44, 95%CI: 0.22, 0.85, p = 0.01) and not associated with an increased risk of perioperative complications (OR = 0.9, 95%CI: 0.68, 1.17, p = 0.42). Black patients also had significantly better one-year overall survival (log-rank p = 0.024) and were associated with a significantly decreased one-year mortality (HR = 0.65, 95%CI: 0.47, 0.91, p = 0.01) after adjusting for multiple clinical factors.
CONCLUSION: Although black patients carried a higher burden of comorbidities, the racial disparity in perioperative outcomes and one-year survival does not persist in TEVAR.