Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative.
Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative.
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DOI：
10.1177/1708538120927704
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发表时间：
2020-12
期刊：
影响因子：
1.1
通讯作者：
Spangler EL
中科院分区：
文献类型：
--
作者：
Stewart L;Pearce BJ;Beck AW;Spangler EL
静脉导管在腹股沟下旁路（IIB）中的通畅性优于假体。在这里，我们探讨了在术前患者和全身因素中IIB静脉导管使用是否存在种族差异。对2003年至2017年期间23，959例IIB闭塞性疾病的回顾性SVS血管质量倡议（VQI）数据进行了分析。对于同质性，仅纳入了源自股总动脉的IIB。比较接受静脉与假体的患者的人口统计学资料，并对种族和术前因素进行逻辑回归分析，以评估静脉导管使用的预测因素。调整后的回归模型显示，与白色患者相比，黑人患者有76%的可能性（p<0.001），西班牙裔患者有79%的可能性（p= 0.003）。与静脉使用正相关的因素包括静脉标测、更远的旁路靶点、组织缺损或急性缺血旁路适应症、商业保险和体重。反对静脉使用的因素包括高龄、女性、阿萨4级、紧急手术、术前活动受限、既往CABG或腿部搭桥术、既往吸烟、术前抗凝和在美国南部或2012年之前进行的搭桥术。虽然黑人和西班牙裔患者不太可能接受静脉，但他们的静脉映射率与其他组相似或更高。在IIB的管道使用方面存在种族差异，黑人和西班牙裔患者接受静脉旁路的可能性较小。然而，在调整和未调整的模型中，种族对管道选择的贡献很小。总体而言，VQI中的术前变量对IIB的静脉导管使用预测不佳。
Vein conduit is known to have better patency than prosthetic for infrainguinal bypass (IIB). Here we explore if racial disparities exist in IIB vein conduit use amid pre-operative patient and systemic factors. Retrospective SVS Vascular Quality Initiative data (VQI) for 23,959 IIB between 2003–17 for occlusive disease were analyzed. For homogeneity, only IIB originating from the common femoral artery were included. Demographics of patients receiving vein vs prosthetic were compared and logistic regression analyses were performed with race and preoperative factors to evaluate for predictors of vein conduit use. Adjusted regression models demonstrated black patients were 76% as likely (p<.001) and Hispanic patients 79% as likely (p=.003) to have vein conduit compared to white patients. Factors positively correlating with vein use included vein mapping, more distal bypass target, tissue loss or acute ischemia bypass indications, commercial insurance, and weight. Factors against vein use included advanced age, female gender, ASA class 4, urgent procedure, preoperative mobility limitation, prior CABG or leg bypass, prior smoking, preoperative anticoagulation, and a bypass performed in the Southern US or before 2012. While black and Hispanic patients were less likely to receive vein, they were vein mapped at similar or higher rates than other groups. Racial disparities exist in conduit use for IIB, with black and Hispanic patients less likely to receive vein bypasses. However, the contribution of race to conduit selection is small in adjusted and unadjusted models. Overall, pre-operative variables in the VQI poorly predicted vein conduit use for IIB.
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影响因子：
4.3
作者：
Soden PA;Zettervall SL;Deery SE;Hughes K;Stoner MC;Goodney PP;Vouyouka AG;Schermerhorn ML;Society for Vascular Surgery Vascular Quality Initiative
通讯作者：
Society for Vascular Surgery Vascular Quality Initiative
影响因子：
5.4
作者：
Arya S;Binney Z;Khakharia A;Brewster LP;Goodney P;Patzer R;Hockenberry J;Wilson PWF
通讯作者：
Wilson PWF
影响因子：
4.3
作者：
Slim, Hani;Tiwari, Alok;Rashid, Hisham
通讯作者：
Rashid, Hisham
影响因子：
2.2
作者：
Selvarajah, Shalini;Black, James H., III;Abularrage, Christopher J.
通讯作者：
Abularrage, Christopher J.
影响因子：
1.5
作者：
Suckow, Bjoern D.;Kraiss, Larry W.;Goodney, Philip P.
通讯作者：
Goodney, Philip P.