Race-based disparities in presentation and outcomes in infrainguinal bypass patients

Racial disparities in healthcare are well documented, however their effects on surgical outcomes remain controversial. While studies have examined outcomes along the white-black dichotomy, Asian populations remain frequently unstudied. We use the VQI to examine disparities among white, black and Asian patients undergoing infrainguinal bypass.

The VQI database was queried for black, white and Asian patients undergoing infrainguinal surgery between 2012 and 2017. Preoperative characteristics, disease severity, and perioperative characteristics were compared between the racial groups. Primary outcomes included overall mortality, time to death, long term loss of primary patency, and patency at discharge. Analyses were done using a 1:3:3 matched sample of Asian to whites to black patients.

Among the patients included, 139 (0.56%) were Asian, 4222 (16.9%) were black and 20,582 (82.5%) were white, of which 129 Asian patients were matched to 387 black and 387 white patients. Asian patients had more advanced disease as demonstrated by higher rates of tissue loss/acute ischemia (P<0.0001) and the highest percentage of below knee popliteal target sites (P=0.0011). There were no differences in mortality (P=0.6808) or long-term loss of primary patency (P=0.4500). However, black patients had higher rates of amputation (OR=1.68, P=0.0224) and reoperation (OR=2.22, P=0.0015).

Asian patients presented with more advanced disease requiring more distal bypass targets. Despite these disparities in presentation, overall long-term primary patency and mortality showed no significant difference.