Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.
J Vasc Surg. 2021 Jun;73(6):2071-2080.e2. doi: 10.1016/j.jvs.2020.10.087. Epub 2020 Dec 3.
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 1-year survival of Black vs White patients undergoing TEVAR in a national vascular surgery database.
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 1-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 1-year survival.
A total of 2669 patients with TEVAR were identified in the Vascular Quality Initiative, of whom 648 were Black patients (24.3%). Compared with White patients, Black patients were younger and had a higher burden of comorbidities, including hypertension, diabetes, congestive heart failure, dialysis dependence, 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 = .1). After adjustment for demographics, comorbidities, and operative factors, Black patients were independently associated with a 56% decrease in 30-day mortality risk compared with their White counterparts (odds ratio, 0.44; 95% confidence interval [CI], 0.22-0.85; P = .01) and not associated with an increased risk of perioperative complications (odds ratio, 0.90; 95% CI, 0.68-1.17; P = .42). Black patients also had a significantly better 1-year overall survival (log-rank, P = .024) and were associated with a significantly decreased 1-year mortality (hazard ratio, 0.65; 95% CI, 0.47-0.91; P = .01) after adjusting for multiple clinical factors.
Although Black patients carried a higher burden of comorbidities, the racial disparities in perioperative outcomes and 1-year survival do not persist in TEVAR.
开放性胸主动脉瘤修复术的种族差异已有充分记录，与白人患者相比，黑种人患者的预后较差。目前尚不清楚这些差异是否会延伸到微创性胸主动脉腔内修复术（TEVAR）。本研究旨在通过国家血管外科学数据库，检查黑人与白人患者接受 TEVAR 的临床特征、围手术期结果和 1 年生存率。
回顾性查询血管质量倡议数据库，以确定 2011 年 1 月至 2019 年 12 月期间接受 TEVAR 的所有患者。主要结局为 TEVAR 后 30 天死亡率和 1 年生存率。次要结局包括各种类型的主要术后并发症。采用多变量逻辑回归分析确定 30 天死亡率和围手术期并发症的预测因素。采用多变量 Cox 回归分析确定 1 年生存率的预测因素。
血管质量倡议数据库中共确定了 2669 例接受 TEVAR 的患者，其中 648 例为黑人患者（24.3%）。与白人患者相比，黑人患者更年轻，合并症负担更重，包括高血压、糖尿病、充血性心力衰竭、透析依赖和贫血。黑人患者更有可能出现症状，表现为主动脉夹层，需要紧急或紧急修复。黑人患者和白人患者的 30 天死亡率无统计学差异（3.4%比 4.9%；P=0.1）。在调整人口统计学、合并症和手术因素后，黑人患者与白人患者相比，30 天死亡率风险降低 56%，独立相关（优势比，0.44；95%置信区间[CI]，0.22-0.85；P=0.01），与围手术期并发症风险增加无关（优势比，0.90；95%CI，0.68-1.17；P=0.42）。黑人患者的 1 年总体生存率也显著提高（对数秩检验，P=0.024），并且在调整多个临床因素后，黑人患者的 1 年死亡率显著降低（风险比，0.65；95%CI，0.47-0.91；P=0.01）。
尽管黑人患者合并症负担更重，但在 TEVAR 的围手术期结果和 1 年生存率方面，种族差异并不存在。
