SAVS Home SAVS Annual Meeting
Search Meeting Site Only
 

Back to Annual Meeting Posters


OUTCOMES AFTER CAOTID ARTERY SURGERY: DOES RACE MAKE A DIFFERENCE?
Muhammad Asad Khan, Kuldeep Singh, Jonathan Schor, Jonathan Deitch
Staten Island University Hospital, Staten Island, NY

INTRODUCTION: Carotid occlusive disease is a major cause of stroke, accounting for 20-25% of cases in USA. Several studies have described a higher incidence of stroke and attributed mortality in minority ethnic groups. The Purpose of this study was to identify ethnic disparity in terms of risk profile, clinical presentation and outcome in patients undergoing carotid endartrectomy using national database.
METHODS: Using National Surgical Quality Improvement Program (NSQIP) data file from year 2005-2007, we identified patients undergoing carotid endartrectomy, CPT code (35301). Patients were divided into two groups based on ethnicity into white and non-white. Patients demographic, comorbidities, clinical presentation, post-operative morbidity and mortality were compared between groups using chi-square and t-test as appropriate.
RESULTS: Among 21,993 patients included in the study, 19,202 (87.3%) were white and 2,791 (12.7%) were non-white. Minority non-white group, were more likely to present with symptomatic carotid occlusive disease (7.5% vs. 4.8%, p<.001), procedure was done emergently (2.3% vs. 1.4%, p<.001), were younger (69.8 vs. 71.7, p<.001) and higher proportion of females (43.5 vs. 40.9%, p = .010), The non white group also had significantly higher cardiovascular risk factors including smoking, diabetes, coronary artery disease, history of coronary revascularization, COPD and end-stage renal disease (Table). Although there was no difference in postoperative MI, stroke, patients with non-white ethnicity had higher overall postoperative morbidity (5.3% vs. 4.0%, p = .001), mortality (1.2% vs. 0.06, p = .001) and total hospital duration (3.3 ± 6.9 vs. 2.3 ± 3.6, p<.001).
CONCLUSION: Review of the NSQIP database revealed ethnic minority group of patients presented with advance carotid occlusive disease at time of carotid surgery compared to the white population. This group also had higher postoperative morbidity and mortality and presented with higher number of cardiovascular risk factors. The findings may be due to delay in seeking treatment, limited access to care, and less rigorous screening . Further studies are required to identify factors delaying care for carotid occlusive disease in the non-white population.
White
N= 19202 (87.3%)
Non-White
2791 (12.7%)
P-value
Symptomatic disease925 (4.8%)208 (7.5%)<.001
Emergency Case264 (1.4%)64 (2.3%)<.001
Female Gender7857 (86.6%)1214 (13.4%)0.01
Age71.1 ± 9.369.8 ± 9.2<.001
HTN16366(85.2%)2399 (86. %).330
MI269 (1.4%)45 (1.6%).395
Acute CHF in 30 days150 (0.8%)30 (1.1%).111
COPD2078 (10.8%)202 (7.2%)<.001
IDDM1651 (8.6%)349 (12.5%)<.001
NIDDM3411 (17.8%)632 (22.6%)<.001
Smoker5296 (27.6%)826 (29.6%).028
PCI3635 (18.9%)462 (2.1%).003
CABG4485 (23.4%)561 (20.1%)<.001
HTN16366 (85.2%)2399 (86%).330
ESRD152 (0.8%)53 (1.9%)<.001
ASA III/Above2381 (12.4%)380 (13.6%).070
Postoperative variables
Stroke/CVA296 (1.5%)41 (1.5%).861
Coma > 24 hours17 (0.1%)6 (0.2%).062
MI120 (0.6%)16 (0.6%).885
SSI42 (0.2%)6 (0.2%)1
Sepsis85 (0.4%)39 (1.4%)<.001
Respiratory complications316 (1.6%)78 (2.8%)<.001
Renal complication37 (0.2%)10 (0.4%).081
Morbidity765 (4.0%)148 (5.3%).001
Death124 (0.6%)34 (1.2%).001
Length of Surgery114 ± 44119 ± 46<.001
Duration of Hospital stay2.3 ± 3.63.3 ± 6.9<.001


Back to Annual Meeting Posters

 

© 2019 Southern Association for Vascular Surgery. All Rights Reserved. Read the Privacy Policy.