VESS14 - African American Women are more likely to Undergo Carotid Endarterectomy for a Higher Degree of Stenosis and Have Increased Risk of Return to the Operating Room as compared to White Women

Objectives: Racial and gender disparities in healthcare outcomes including surgery is a well-known phenomenon. Some of these disparities have been attributed to social determinants of health which affect access to quality care and preventative medicine. In this study, we analyse differences in outcomes by race and gender following endarterectomy for carotid stenosis.

Methods: All adult females undergoing carotid endarterectomy for an indication of carotid stenosis in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) between 2012 and 2021 were stratified between Black females (Group I) and White females (Group II). Primary outcomes include 30-day mortality, stroke and return to the operating room (OR). Secondary outcomes included length of stay (LOS) and operative time. A p-value of < 0.05 was considered statistically significant.

Results: The study population included 10,564 patients, of which 764 (7.23%) are in Group I and 9,800 (92.7%) in Group II. Of these, 6,302(59.65%) were asymptomatic (6.42% Black females and 93.58% White females). Patients in Group I were more likely to present with ipsilateral stroke (27.09% vs 17.18%, p< 0.001), severe ipsilateral stenosis (80-99% of stenosis) (67.80% vs 66.20%, p< 0.001) or ipsilateral total occlusion (100% stenosis) (1.57% vs 0.69%, p< 0.001) as compared to Group II. Group I was also observed to have severe contralateral stenosis (80-99%) (7.46% vs 6.39%, p=0.004), less likely to be on aspirin (16.49% vs 10.95%, p< 0.001) and less likely to undergo an elective procedure (24.08% vs 15.90%, p< 0.001). For post-operative outcomes, patients in Group I had higher risk of Return to the OR (3.66% vs 2.28%, p=0.015), longer operative time [Mean:126.15mins (SD- ± 44.08) vs 112.29mins (± 45.70), p< 0.001] and longer LOS [3.9days (±6.38) vs 2.56 days (± 4.52), p< 0.001]. There were no significant differences in mortality (p=0.290) and stroke (p=0.210).

Conclusions: African American females tend to present with more severe forms of carotid disease, such as severe stenosis or total carotid occlusion. They are also at a higher risk for return to the operating room, longer operative time and longer length of stay. This study highlights the effect of inadequate care on clinical outcomes and the importance of early access to quality preventative care, education among minority groups and referral to vascular surgeons by primary care physicians.