revascularization

outcomes for Black patients, study finds

Research findings highlight the persistence of unequal treatment outcomes for Black patients with peripheral artery disease (PAD).

Such disparities often are attributed to sociodemographic factors. However, Dana B. Semann, MD, presented research that adjusted for socioeconomic status in a propensity-matched analysis of comorbidities and socioeconomic factors affecting Black patients who have worse outcomes after lower-extremity revascularization.

The research aimed to investigate the impact of socioeconomic status, specifically using the area of deprivation index (ADI), on the outcomes of lower extremity bypass (LEB) and peripheral vascular intervention (PVI) procedures for Black and non-Hispanic white (NHW) patients.

Researchers utilized Vascular Quality Initiative (VQI) datasets from 2016 to 2021, to identify patients who underwent the two procedures. They analyzed 44,968 PVI and 12,006 LEB procedures after matching patients based on comorbidities, ADI, indication, urgency and the number of arteries treated (PVI) or graft target (LEB).

The primary outcome measured was the absence of major adverse limb events (MALE) at one year. The findings revealed higher rates of MALE at one year for Black patients in both procedure groups. Adjusted analyses indicated that Black patients with chronic limb-threatening ischemia (CLTI) faced a higher risk of MALE at one year for both procedures than their NHW counterparts. “Despite adjusting for socio-economic factors using the validated ADI, Black patients with PAD have worse outcomes following revascularization, especially for CLTI, suggesting that other factors adversely affect outcomes in these patients.,” Semaan concluded. “These unmeasured factors require further exploration to improve PAD outcomes in Black patients.”

Discussant Olamide Alabi, MD, raised concern about the high number of amputations in Black and Brown communities that comorbidities cannot explain and asked the audience to consider the reasons for this.

“In other words, what are we missing, what social and political determinants of amputations have not yet defined and what role does implicit bias play on the Black/white racial disparity that’s seen in major amputation among those with PAD?” asked Alabi.

Semaan said future studies should measure the implicit bias among vascular surgeons and primary care physicians and determine if such bias impacts patient outcomes.

The study’s results underscore the persistent challenges in achieving equitable health care outcomes and highlight the importance of addressing racial disparities in PAD, said Semaan. The findings call for continued efforts to identify and understand the factors contributing to these disparities, intending to develop targeted interventions and strategies to improve PAD outcomes for Black patients.

Young surgeons and surgeons in private practice take the stage Friday for sessions geared specifically to their members’ interests and needs.

The Community Practice Section holds its educational session, “Recognizing, Enhancing and Promoting the Value of the Vascular Surgeon,” will be from 1:30–3 p.m. today in Maryland A. Topics run the gamut of introducing new programs to members’ hospitals, a vascular surgeon’s financial value— always a source of interest and concern for vascular surgeons—and talking with hospital top administrators.

Talks are: “Ancillary value of the vascular surgeon for the healthcare system and hospitals,” “Financial value of the vascular surgeon for the healthcare system and hospitals,” “Introducing TCAR or PERT to your hospital,” followed by a panel discussion.

Final talks of the afternoon are: “Enhancing your practice with advanced practice providers (APPs): Effective strategies to consider,” “Whether to get an MBA” and “Gaining access to C-suite: Talking and negotiating with hospital administration,” followed by a panel discussion of relevant concerns.

Section leaders then will present the Excellence in Community Practice Award, which recognizes an individual’s sustained contributions to patients and his or her community, as well as exemplary professional practice and leadership.

Members of the Young Surgeons Section will host “Welcome to the First Five Years of Practice—Things We Should All Know” from 3:30–5 p.m., also in Maryland A.

Topics cover many issues important to surgeons just starting out after training, including presentations on pursuing research or private practice and how these younger surgeons can make themselves known in the vascular surgery world.

Talks include: “Finding the right practice for you and advice on switching your practice,” “Branding yourself as a vascular surgeon,” and “Managing relationships with industry.”

Also: “The business side of a vascular surgery practice,” “Life planning for a vascular surgery career” and “How to build a clinical research program.” A 30-minute panel discussion will complete the program.