Comparative assessment of racial disparity in 30-day outcomes for Asian Americans undergoing carotid endarterectomy

Document Type

Journal Article

Publication Date

12-22-2023

Journal

Journal of vascular surgery

DOI

10.1016/j.jvs.2023.12.038

Keywords

Asian American; carotid endarterectomy; carotid stenosis; healthcare access; racial disparity

Abstract

BACKGROUND: Carotid endarterectomy (CEA) is an effective treatment for carotid stenosis. All previous studies on racial disparity of CEA outcomes omitted Asian Americans. This study aimed to address this gap by investigating racial disparities in 30-day outcomes following CEA among Asian Americans. METHODS: Asian American and Caucasian patients who underwent CEA were identified in the ACS-NSQIP targeted database from 2011 to 2021. Patients with age less than 18 years old were excluded. Patients with symptomatic and asymptomatic carotid stenosis were examined separately. A 1:5 propensity-score matching was used to address pre-operative differences. Thirty perioperative outcomes were assessed. RESULTS: There were 380 (2.27%) Asian Americans and 13,250 (79.18%) Caucasians with symptomatic carotid stenosis who underwent CEA. Also, 289 (1.40%) Asian Americans and 18,257 (88.14%) Caucasians with asymptomatic carotid stenosis had CEA. Asian Americans undergoing CEA presented with higher comorbid burdens and more severe symptomology. Also, asymptomatic Asian Americans were more likely to undergo surgeries for mild stenosis (<50%) which is not in line with practice guidelines. After 1:5 propensity-matching, all symptomatic Asian Americans were matched to 1,550 Caucasian patients, and all asymptomatic Asian Americans were matched to 1,445 Caucasians, preoperative differences were addressed. Asian Americans exhibited low overall 30-day mortality (symptomatic 1.61%, asymptomatic 0.35%) and stroke (symptomatic 2.26%, asymptomatic 0.69%). All perioperative outcomes were comparable to Caucasians, with the exception that Asian Americans experienced longer operation times. CONCLUSION: Evidence suggested that Asian Americans with asymptomatic stenosis were underrepresented in CEA. After propensity-score matching, Asian Americans demonstrated comparable 30-day outcomes to Caucasians. These suggest that, when afforded equal access to quality healthcare, CEA serves as an effective treatment for carotid stenosis among Asian Americans. Therefore, efforts may be aimed at addressing healthcare access, potentially in the screening for asymptomatic carotid stenosis in Asian Americans. This would ensure they have equitable benefits from CEA. Nevertheless, the exact preoperative differences and long-term CEA outcomes in Asian Americans should warrant further examination in future studies.

Department

Surgery

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