African Americans Are at a Higher Risk for Limb Loss but Not Mortality after Lower Extremity Bypass Surgery

Background: Lower extremity revascularization is the gold standard for treatment of symptomatic peripheral arterial disease. The objective of this study was to examine the impact of race on 30-day outcomes among patients with peripheral arterial disease who have undergone open lower extremity bypass. Methods: Data were obtained from the 2013 American College of Surgeons National Surgical Quality Improvement Program database using Procedure Participant User File. Patients were divided into three groups based on race: white, African American, and Hispanic. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors among races. Multivariable analysis was used to determine associations of independent variables with mortality and lower extremity amputation as primary outcomes. Results: A total of 2,381 patients (31.9% Females, 68.1% Males) were identified in the National Surgical Quality Improvement Program database who underwent lower extremity bypass in the year 2013. Among these patients, 1,732 (72.74%) were non-Hispanic white, 488 (20.50%) were non-Hispanic African American, and 161 (6.76%) were Hispanic. African American patients were more likely to have hypertension, be on dialysis, and present with rest pain and tissue loss (P < 0.001). They were also more likely to be readmitted within 30 days (P = 0.003). On multivariable analysis, the following factors were found to have significant association with amputation: African American race (vs. white race, OR 2.8, CI 1.76–4.56, P < 0.001), elective surgery (OR 2.5, CI 1.59–3.93, P < 0.001), dialysis (OR 2.36, CI 1.28–4.37, P = 0.006), and major reintervention on the bypass (OR 11.56, CI 6.99–19.12, P < 0.001). Factors that have significant associations with mortality in the multivariable analysis include 60–69 years of age (vs. <60 years of age, OR 13.6, CI 2.40–77.21, P = 0.005), 70–79 years of age (vs. <60 years of age, OR 10.22, CI 1.74–59.90, P = 0.005), ≥80 years of age (vs. <60 years of age, OR 23.85, CI 3.94–144.30, P = 0.005), dialysis (OR 12.71, CI 6.14–26.33, P < 0.001), stroke or cardiovascular accident (OR 11.48, CI 2.05–64.40, P = 0.006), cardiac arrest requiring cardiopulmonary resuscitation (OR 145.09, CI 54.46–386.54, P < 0.001), acute renal failure postoperatively (OR 31.59, CI 7.53–132.51, P < 0.001), and return to the operating room (OR 2.66, CI 1.27–5.57, P = 0.009). Conclusions: African American patients were more likely than white and Hispanic patients to undergo major amputation after open lower extremity bypass. Unlike previously published data, this study does not show any difference in mortality.