Thoracic Endovascular Aneurysm Repair, Race, and Volume in Thoracic Aneurysm Repair

Study Questions:

Are there racial disparities in the outcomes of individuals with thoracic aortic aneurysm (TAA) undergoing open repair or thoracic endovascular aneurysm repair (TEVAR)?

Methods:

The study used Medicare claims to identify 12,573 individuals undergoing open TAA repair and 2,732 patients undergoing TEVAR, and evaluated 30-day mortality as stratified by AA versus non-AA race, procedure type, and hospital volume for procedure types. Patients with ascending TAA, thoracic aortic dissections, or thoracoabdominal aneurysms were excluded.

Results:

Mean age was 74 years; 56% were male. In the cohorts undergoing open TAA repair and TEVAR, 4% and 8% of individuals were AA, respectively. The non-AA cohort was 97% white, with no other ethnicity representing >1% of the study cohort. As compared to non-AAs, AAs were slightly younger, less likely male, and had increased prevalence of comorbidities including diabetes, heart failure, and chronic renal failure (p < 0.05 for each). AAs (vs. non-AAs) were more likely to have open surgery (p = 0.003) at lower-volume hospitals, although no differences were observed between groups treated by TEVAR (p = 0.91). AA individuals having open repair had higher unadjusted mortality than non-AAs (14.4% vs. 6.8%, p < 0.001), but no difference was observed in those having TEVAR (7.1% vs. 6.1%, p = 0.56). After adjustment for age, gender, comorbidities, and procedural volume, AA patients (vs. non-AAs) had higher 30-day mortality following open repair (odds ratio, 2.0; 95% confidence interval, 1.5-2.5; p < 0.001), but not TEVAR (odds ratio, 0.9; 95% confidence interval, 0.6-1.5; p = 0.72).

Conclusions:

The authors concluded that AA individuals with TAA undergoing open repair have higher adjusted mortality than non-AA individuals, with no difference observed in those treated by TEVAR.

Perspective:

This study finds concerning racial disparities between AA and non-AA individuals undergoing open repair of TAA, which are not entirely explained by risk factors and hospital volume. In concert with existing recognition of other disparities in cardiovascular disease outcomes, these findings suggest a need to identify and address potential causes of these differences. Notably, this study did not observe a difference between races in outcomes following TEVAR, and future studies may be warranted to determine whether increased utilization and availability of TEVAR may reduce racial disparities in those undergoing TAA repair.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Sleep Apnea

Keywords: Odds Ratio, Blood Vessel Prosthesis Implantation, Continental Population Groups, European Continental Ancestry Group, Comorbidity, Risk Factors, Prevalence, Renal Insufficiency, Recognition (Psychology), Heart Failure, Cardiovascular Diseases, Confidence Intervals, Medicare, United States, Diabetes Mellitus


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