TY - JOUR
T1 - The impact of race and ethnicity on the outcome of carotid interventions in the United States
AU - Schneider, Eric B.
AU - Black, James H.
AU - Hambridge, Hali L.
AU - Lum, Ying Wei
AU - Freischlag, Julie A.
AU - Perler, Bruce A.
AU - Abularrage, Christopher J.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/9
Y1 - 2012/9
N2 - Objective: Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The present study was undertaken to examine the influence of race and ethnicity on the outcomes of CEA and CAS in contemporary practice. Methods: The nationwide inpatient sample (2005-2008) was queried using International Classification of Diseases-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcomes were postoperative death or stroke. Multivariate analysis was performed adjusting for age, gender, race, comorbidities, high-risk status, procedure type, symptomatic status, year, insurance type, and hospital characteristics. Results: Overall, there were 347,450 CEAs and 47,385 CASs performed in the United States over the study period. After CEA, Hispanics had the greatest risk of mortality (P < 0.001), whereas black patients had the greatest risk of stroke (P = 0.02) compared with white patients on univariate analysis. On multivariable analysis, Hispanic ethnicity remained an independent risk factor for mortality after CEA (relative risk 2.40; P < 0.001), whereas the increased risk of stroke in black patients was no longer significant. After CAS, there were no racial or ethnic differences in mortality. On univariate analysis, the risk of stroke was greatest in black patients after CAS (P = 0.03). However, this was not significant on multivariable analysis. Conclusion: Hispanic ethnicity is an independent risk factor for mortality after CEA. While black patients had an increased risk of stroke after CEA and CAS, this was explained by factors other than race. Further studies are warranted to determine if Hispanic ethnicity remains an independent risk factor for mortality after discharge.
AB - Objective: Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The present study was undertaken to examine the influence of race and ethnicity on the outcomes of CEA and CAS in contemporary practice. Methods: The nationwide inpatient sample (2005-2008) was queried using International Classification of Diseases-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcomes were postoperative death or stroke. Multivariate analysis was performed adjusting for age, gender, race, comorbidities, high-risk status, procedure type, symptomatic status, year, insurance type, and hospital characteristics. Results: Overall, there were 347,450 CEAs and 47,385 CASs performed in the United States over the study period. After CEA, Hispanics had the greatest risk of mortality (P < 0.001), whereas black patients had the greatest risk of stroke (P = 0.02) compared with white patients on univariate analysis. On multivariable analysis, Hispanic ethnicity remained an independent risk factor for mortality after CEA (relative risk 2.40; P < 0.001), whereas the increased risk of stroke in black patients was no longer significant. After CAS, there were no racial or ethnic differences in mortality. On univariate analysis, the risk of stroke was greatest in black patients after CAS (P = 0.03). However, this was not significant on multivariable analysis. Conclusion: Hispanic ethnicity is an independent risk factor for mortality after CEA. While black patients had an increased risk of stroke after CEA and CAS, this was explained by factors other than race. Further studies are warranted to determine if Hispanic ethnicity remains an independent risk factor for mortality after discharge.
KW - Carotd
KW - Endarterctomy
KW - Mortality
KW - Nationwide Inpatient Sample
KW - Stent
KW - Stroke
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U2 - 10.1016/j.jss.2012.02.050
DO - 10.1016/j.jss.2012.02.050
M3 - Article
C2 - 22459294
AN - SCOPUS:84865065726
SN - 0022-4804
VL - 177
SP - 172
EP - 177
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -