Impact of Ethnicity and Race on Outcomes after Thoracic Endovascular
Aortic Repair
Abstract
Introduction Thoracic endovascular aortic repair (TEVAR)
became the standard of care for treating type B aortic dissections and
descending thoracic aortic aneurysms. We aimed to describe the
racial/ethnic differences in TEVAR utilization and outcomes.
Methods The National Inpatient Sample was reviewed for
all TEVARs performed between 2010 and 2017 for Type B aortic dissection
and descending thoracic aortic aneurysm (DTAA). We compared groups
stratifying by their racial/ethnicity background in whites, black,
Hispanic, and others. A mixed-effects logistic regression was performed
to assess the relationship between race/ethnicity and the primary
outcome, in-hospital mortality. Results A total of
25,260 admissions for TEVAR during 2010–2017 were identified. Of those,
52.74% (n= 13,322) were performed for aneurysm and 47.2% (n= 11,938)
were performed for type B dissection. 68.1% were white, 19.6% were
black, 5.7% Hispanic, and 6.5% were classified as others. White
patients were the oldest (median age 71 years; <0.001), with
TEVAR being performed electively more often for aortic aneurysm (58.8%
vs. 34% vs. 48.3% vs. 48.2%; p<0.001). In contrast, TEVAR
was more likely urgent or emergent for type B dissection in black
patients (65.6% vs 41.1% vs 51.6% vs 51.7%; p<0.001).
Finally, the black population showed a relative increase in the
incidence rate of TEVAR over time. The adjusted multivariable model
showed that race/ethnicity was not associated with in-hospital
mortality. Conclusion Although there is a differential
distribution of thoracic indication and comorbidities between
race/ethnicity in TEVAR, racial disparities do not appear to be
associated with in-hospital mortality after adjusting for covariates.