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 one-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 one-year survival.
A total of 2669 patients with TEVAR were identified in the VQI, of whom 648 were black patients (24.3%). Compared to white patients, black patients were younger and associated with a higher burden of comorbidities, including hypertension, diabetes, congestive heart failure, dialysis-dependent, 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 = 0.1). After adjustment for demographics, comorbidities, and operative factors, black patients were independently associated with a 56% reduction in 30-day mortality risk compared with their white counterparts (OR = 0.44, 95%CI: 0.22, 0.85, p = 0.01) and not associated with an increased risk of perioperative complications (OR = 0.9, 95%CI: 0.68, 1.17, p = 0.42). Black patients also had significantly better one-year overall survival (log-rank p = 0.024) and were associated with a significantly decreased one-year mortality (HR = 0.65, 95%CI: 0.47, 0.91, p = 0.01) after adjusting for multiple clinical factors.
Although black patients carried a higher burden of comorbidities, the racial disparity in perioperative outcomes and one-year survival does not persist in TEVAR.
Copyright © 2020. Published by Elsevier Inc.