The impact of race and insurance type on the outcome of endovascular abdominal aortic aneurysm (AAA) repair
Presented at the 2007 Vascular Annual Meeting of the Society for Vascular Surgery, Philadelphia, Pa, June 6-10, 2007.
Received 4 April 2007; accepted 11 January 2008. published online 14 April 2008.
Background
Although mortality and complication rates for abdominal aortic aneurysm (AAA) have declined over the last 20 years, operative complication rates and perioperative mortality are still high, specifically for repair of ruptures. The goal of this study was to determine the influence of insurance type and ethnicity while controlling for the influences of potential confounders on procedure selection and outcome following endovascular AAA repair (EVAR).
Methods
Using the Nationwide Inpatient Sample (NIS) database, we identified patients who underwent EVAR repair of ruptured and elective infrarenal AAA, between 1990 and 2003. Insurance type and ethnicity were analyzed against the primary outcome variables of mortality and major complications. The potential confounders of age, gender, operative location, diabetes, and Deyo index of comorbidities, were controlled.
Results
Bivariate analyses demonstrated significant differences between insurance types and ethnicity and mortality and complications. Patients who were self pay had adverse outcomes in comparison to Private insurance. Whites encountered less perioperative mortality and postoperative complications than Blacks and Hispanics.
Conclusions
After controlling for previously identified associative factors for AAA outcome, ethnicity and insurance type does influence EVAR surgical outcome. Subsequent studies that break down emergent repair vs elective surgery and that longitudinally stratify delay in surgery, or time to admission may be useful.
aDepartment of Surgery, Duke University Medical Center, Durham, NC
bDepartment of Community and Family Medicine, Duke University Medical Center, Durham, NC
cCenter for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC
dColumbia University, College of Physicians and Surgeons, New York, NY.
Reprint requests: Chad Cook PT, PhD, MBA, FAAOMPT, Department of Community and Family Medicine, Center for Excellence in Surgical Outcomes, Duke University Medical Center, DUMC 3907, Durham, NC 27710.
Competition of interest: none.
This study was commissioned by the SVS Committee on Minority Affairs
ABSTRACT