African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms

Objective: Recently published Society for Vascular Surgery guidelines recommend endovascular aneurysm repair (EVAR) for both elective and emergent treatment of abdominal aortic aneurysm in patients with suitable anatomy. Racial disparities in health care are well known. The aim of this study was to stratify the patients undergoing EVAR on the basis of their racial differences and to determine the differences in preoperative, intraoperative, and postoperative variables among patients of different races. Methods: The 2013 EVAR targeted American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were used for this retrospective study. Patients were divided into three groups by race: whites for non-Hispanic whites, blacks for non-Hispanic blacks, and Hispanic. Bivariate analysis was performed for the patients' demographics and preoperative risk factors. Multivariable analysis was used to determine associations of independent variables with elective surgery as the primary outcome. Results: A total of 1991 patients (18.7% female, 81.3% male) underwent EVAR in 2013. Among these patients, 1824 (91.6%) were white, 121 (6.1%) were black, and 46 (2.3%) were Hispanic. When all patients undergoing EVAR are stratified on the basis of race, we found the following differences: a larger proportion of Hispanic patients were older than 80 years (43% vs 30% for white patients; P <.01); black patients were more likely to have body mass index <25 kg/m² (39.8% vs 25.2% for white patients; P <.01); black patients were more likely to undergo nonelective operation (34.7% vs 17.9% for white patients; P <.01); incidence of active smoking was higher among blacks (44.6% vs 30% for white patients); a higher percentage of black patients were functionally dependent (9.9% vs 2.6% for white patients); and black patients were more likely to be on hemodialysis (6.6% vs 0.9% for white patients). Conclusions: Black patients were less likely to have elective EVAR compared with Hispanic and white patients. The incidence of nonelective EVAR among black patients was higher compared with white patients. Future studies are warranted to investigate whether reduced frequency of elective EVAR among the black population leads to need for nonelective EVAR.