Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Vasc Surg. 2023 May;77(5):1413-1423. doi: 10.1016/j.jvs.2023.01.181. Epub 2023 Jan 23.
Racial differences in elective abdominal aortic aneurysm (AAA) repair outcomes have been previously reported; however, data on racial differences in ruptured AAA (rAAA) repair outcomes remain limited. This study assessed in-hospital and long-term mortality after rAAA repair in Black versus White patients.
The Vascular Quality Initiative database was queried to identify all Black and White patients who underwent open or endovascular rAAA repair between 2003 and 2019. Baseline demographic and clinical characteristics were recorded, and independent t test and χ test were performed to assess differences between groups. In-hospital and 8-year mortality rates were the primary outcomes. Univariate and multivariate logistic regression and Cox proportional hazards analyses were conducted to analyze associations between race and outcomes.
Overall, 310 Black patients and 4679 White patients underwent rAAA repair. A greater proportion of Black patients underwent endovascular repair (73.2% vs 56.1%). Black patients had a lower mean age and were more likely to be female, with a greater proportion being Medicaid insured (9.7% vs 2.1%) or uninsured (4.8% vs 3.3%). Although Black patients were more likely to be current smokers and have hypertension, diabetes, and congestive heart failure, they were not more likely to receive risk reduction medications. The time from symptom onset to incision or access was higher for Black patients (median, 12.0 hours vs 7.0 hours). Similarly, the time from hospital admission to intervention was higher for Black patients (median, 2.8 hours vs 1.3 hours). In-hospital mortality was lower in Black patients (20.0% vs 28.6%; odds ratio [OR], 0.63; 95% confidence interval [CI], 0.47-0.83); however, this did not persist after adjusting for baseline characteristics (adjusted OR, 0.58; 95% CI, 0.30-1.07; P = .09). Furthermore, the 8-year survival was not different between groups (50.4% vs 46.6%; hazard ratio, 0.85; 95% CI, 0.57-1.26; P = .42), even when stratified by repair type.
This study identified racial differences in demographic, clinical, and procedural characteristics for patients undergoing rAAA repair. In particular, the door-to-intervention time for Black patients of 2.8 hours does not meet the Society for Vascular Surgery recommendation of 90 minutes. Despite these differences, the 8-year mortality is similar for Black and White patients. These differences should be investigated further, and there are opportunities to improve rAAA care for Black patients.
先前已有研究报道了择期腹主动脉瘤（AAA）修复术的种族差异；然而，关于破裂性 AAA（rAAA）修复术结局的种族差异的数据仍然有限。本研究评估了黑人和白人患者接受 rAAA 修复后的院内和长期死亡率。
检索血管质量倡议数据库，以确定 2003 年至 2019 年间接受开放或血管内 rAAA 修复的所有黑人和白人患者。记录基线人口统计学和临床特征，并进行独立 t 检验和 χ2 检验，以评估组间差异。院内和 8 年死亡率为主要结局。进行单变量和多变量逻辑回归和 Cox 比例风险分析，以分析种族与结局之间的关系。
总体而言，310 名黑人患者和 4679 名白人患者接受了 rAAA 修复。黑人患者接受血管内修复的比例更高（73.2% vs. 56.1%）。黑人患者的平均年龄较低，更有可能是女性，有更大比例的人是医疗补助保险（9.7% vs. 2.1%）或没有保险（4.8% vs. 3.3%）。尽管黑人患者更有可能是当前吸烟者，且患有高血压、糖尿病和充血性心力衰竭，但他们接受降低风险药物治疗的可能性并不更高。黑人患者从症状发作到切口或入路的时间更长（中位数 12.0 小时 vs. 7.0 小时）。同样，黑人患者从入院到介入治疗的时间也更长（中位数 2.8 小时 vs. 1.3 小时）。黑人患者的院内死亡率较低（20.0% vs. 28.6%；比值比[OR]，0.63；95%置信区间[CI]，0.47-0.83）；然而，在校正基线特征后，这一差异并不显著（校正 OR，0.58；95%CI，0.30-1.07；P=0.09）。此外，两组患者的 8 年生存率无差异（50.4% vs. 46.6%；风险比，0.85；95%CI，0.57-1.26；P=0.42），即使按修复类型分层也是如此。
本研究确定了接受 rAAA 修复的患者在人口统计学、临床和手术特征方面的种族差异。特别是，黑人患者的门到干预时间为 2.8 小时，不符合血管外科学会建议的 90 分钟。尽管存在这些差异，但黑人和白人患者的 8 年死亡率相似。这些差异应进一步调查，并且有机会改善黑人患者的 rAAA 治疗。
