(IP113) Outcomes in American Indian/Alaska Native Patients After Peripheral Vascular Intervention

Objectives: American Indian/Alaska Native (AI/AN) patients have been shown to experience higher rates of post-surgery mortality, major complications, and reoperation as compared to other racial groups, in addition to experiencing higher rates of peripheral arterial disease (PAD) relative to other racial groups. In spite of these well-demonstrated inequities, to our knowledge no studies have been conducted to investigate whether outcomes are equitable between AI/AN patients and white patients undergoing treatment for PAD. Peripheral vascular interventions (PVI) are among the most common treatments for PAD, and we therefore aimed to compare multiple outcome measures of PVI between AI/AN and white patients.

Methods: All AI/AN and white patients undergoing PVI between January 2017 and October 2023 were identified in the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention dataset. Propensity Score-Matched analysis (1:1) was performed for AI/AN vs White. Propensity score-matching was performed for 31 baseline variables, and logistic regression was used to analyze postoperative and one-year outcomes after matching. Postoperative outcomes examined were 30-day mortality, myocardial infraction, and renal complications, while one-year outcomes analyzed were mortality, major amputation, major amputation or death, reintervention, major adverse limb events (MALE), and MALE or death.

Results: A total of 64,347 patients were included [White 63,523; AI/AN 824]. Propensity score matching produced well balanced groups with SD < 0.1. Among 769 AI/AN vs white pairs, AI/AN had 1.40 times the odds of major adverse limb events (MALE) (p=0.024, 95% CI 1.05-1.87) and had 1.36 times the odds of MALE or death (p=0.005, 95% CI 1.10-1.69) (Table I and Figure 1).

Conclusions: This comprehensive multi-institutional study is the first of its kind to probe equity in PVI outcomes for American Indian/Alaska Native patients, and reveals that AI/AN patients experienced higher rates of some negative outcomes following PVI as compared to white patients. This study confirms that outcome disparities which have previously been shown to affect AI/AN patients in other types of surgery are found in PVI outcomes as well, and highlights the need for additional data collection and investigation into whether outcome disparities affect AI/AN patients in other types of vascular procedures.