Racial disparity in early graft failure after infrainguinal bypass
Racial disparity in early graft failure after infrainguinal bypass
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DOI：
10.1016/j.jss.2014.04.029
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发表时间：
2014-07-01
影响因子：
2.2
通讯作者：
Abularrage, Christopher J.
中科院分区：
文献类型：
--
作者：
Selvarajah, Shalini;Black, James H., III;Abularrage, Christopher J.
背景：种族差异已被证明与医疗保健费用的增加有关。我们试图找出腹股沟下旁路术后30天移植失败率的种族差异，以确定改善少数民族健康护理的目标。方法：2005-2011年国家外科质量改进计划数据库查询外周动脉疾病患者接受腹股沟下旁路作为其主要程序。进行了双变量分析，以评估不同种族（白人、黑人和西班牙裔）的术前和术中风险因素。多变量logistic回归分析评估种族与30-d移植失败的独立相关性。结果：在总共16,276例患者中，12,536例（77.0%）为白人，2940例（18.1%）为黑人，800例（4.9%）为西班牙裔。黑人患者更可能是年轻、女性、目前吸烟者和透析患者（P < 0.001）。此外，与黑人和西班牙裔相比，白人出现严重肢体缺血的可能性更小（分别为44.2%、55.4%和52.8%; P < 0.001）。同样，白人接受股骨-胫骨（分别为31.4%对34.7%对38.6%）或腘-胫骨水平旁路术（分别为8.9%对13.4%对16.1%）的人数少于黑人和西班牙裔（P < 0.001）。两组之间自体导管的使用无差异（P = 0.266）。在比例上，黑人比白人更易发生早期移植失败（6.7%比4.5%; P < 0.001），但西班牙裔与白人之间没有差异（6.0%比4.5%; P = 0.057）。在多变量分析中，黑人种族与早期移植失败独立相关（调整后的比值比1.26，95%置信区间1.05-1.51; P = 0.011）。结论：更多的黑人和西班牙裔存在严重的肢体缺血，需要远端血运重建。即使在控制了解剖学差异和外周动脉疾病程度后，黑人仍然与腹股沟下旁路术后早期移植失败独立相关。这些结果确定了改进成果的目标。(C)2014爱思唯尔公司All rights reserved.
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. (C) 2014 Elsevier Inc. All rights reserved.