Results:

A total of 4,935 patients with rAAAs in the Vascular Quality Initiative (6.2% Black) and 48,489 in the National Inpatient Sample (6.0% Black) were identified. The rates of transfer were high; however, Black patients were significantly less likely to undergo transfer before repair compared with White patients (49% Black vs. 62% White; p = 0.002). The result was consistent in both crude and adjusted analyses when considering only stable patients and was not modified by insurance status, surgery type, or hospital volume. No significant differences were found in perioperative mortality (22% vs. 26%; p = 0.098) or complications (52% vs. 52%; p = 0.64). However, Black patients were significantly more likely to be turned down for repair (37% vs. 28%; odds ratio, 1.5; 95% confidence interval, 1.2-1.9; p < 0.001). A significant interaction was found between race and insurance status with respect to turndown. Patients with private insurance had undergone surgery at a similar rate, regardless of race. However, among patients with Medicare or Medicaid/self-pay, Black patients were less likely than were White patients to undergo repair (Medicare, 64% vs. 72%; p = 0.001; Medicaid/self-pay, 43% vs. 61%; p = 0.031). Patients with Medicaid/self-pay were also less likely to undergo repair than were patients of the same race with either Medicare or private insurance (p < 0.05).