SS04 - Racial and Ethnic Disparities in Long-term Outcomes Following Open Revascularization for Chronic Limb Threatening Ischemia

Objectives: Black and Hispanic patients have higher rates of chronic limb-threatening ischemia (CLTI) and suffer worse perioperative outcomes after lower extremity bypass compared with White patients. The underlying reasons for these disparities are unclear, and data on long-term outcomes are limited. Therefore, we examined differences in 3-year outcomes after open infrainguinal revascularization for CLTI by race/ethnicity and explored potential factors contributing to these differences.

Methods: We identified all CLTI patients undergoing primary open infrainguinal revascularization in the Vascular Quality Initiative registry from 2003-2017 with linkage to Medicare through 2018 for long-term outcomes. Our primary outcomes were 3-year amputation, re-intervention, and survival. Secondary outcomes were factors associated with disparate outcomes. We used Kaplan-Meier and Cox regression analyses to evaluate outcomes by race and ethnicity and to identify contributing factors.

Results: Among 7,108 CLTI patients, 5,599 (79%) were non-Hispanic White, 1,053 (15%) were Black, 48 (1%) were Asian, and 408 (6%) were Hispanic (Table). Black patients had higher rates of 3-year amputation (32% vs 19%; hazard ratio (HR):1.9 [95% confidence interval: 1.7-2.2]), re-intervention (61% vs 57%; HR:1.2 [1.1-1.3]), and survival (62% vs 58%; HR:1.1[1.01-1.2]) compared with White patients. Hispanic patients experienced higher rates of amputation (27% vs 19%; HR:1.6 [1.3-2.0]) and re-intervention (70% vs 57%; HR:1.4 [1.2-1.6]) compared with White patients; however, survival was similar between the groups (62% vs 58%; HR: 1.1 [0.98-1.3]). The low number of Asian patients prevented meaningful assessment of amputation (20% vs 19%; HR:0.9 [0.4-2]), re-intervention (55% vs 57%; HR: 0.8 [0.5-1.2]), or survival (64% vs 58%; HR:1.2 [0.8-1.9]) in this group. In adjusted analyses, the association of Black and Hispanic race with amputation and re-intervention was explained primarily by differences in demographic characteristics (age, sex) and baseline comorbidities (tobacco use, diabetes, renal disease).

Conclusions: Compared with White patients, Black and Hispanic patients had higher 3-year amputation and re-intervention rates; however, survival was higher among Black patients and similar between Hispanic and White patients. Disparities in amputation and re-intervention rates are partly attributable to demographic characteristics and the higher prevalence of comorbidities in Black and Hispanic patients with CLTI. Interventions to improve early diagnosis, risk factor modification, and post-operative surveillance in these populations may confer long-term limb salvage benefits.