3 years ago

Variation in Amputation Risk for Black Patients: Uncovering Potential Sources of Bias and Opportunities for Intervention

Differences in amputation rates for limb ischemia between white and black patients have been extensively studied. Our goal is to determine whether biases in provider decision-making contribute to the disparity. We hypothesize that the magnitude of the disparity is affected by surgeon and hospital factors. Study Design Analysis of the New York Statewide Planning and Research Cooperative System database was performed for 1999-2014. Black and white patients with ICD9 codes for peripheral vascular disease, who received either an amputation or salvage procedure, were included. Primary endpoint was treatment choice. Results 215,480 inpatient admissions were analyzed. Overall amputation rate was 38.0%, and blacks were significantly more likely to receive amputations than whites on unadjusted (42.6% vs 28.6%, p<0.001), and multivariable analyses (OR 1.45, 95% CI 1.31-1.60, P<0.001). This difference was more pronounced amongst high total vascular volume surgeons (OR 1.74, 95% CI 1.50-2.00, p<0.001) but not amongst those with low total vascular volume (OR 1.06, 95% CI 0.90-1.24, p=0.49); high volume hospitals (OR 1.57, 95% CI 1.39-1.78, p<0.001), but not amongst those with low amputation volume (OR 0.96, 95% CI 0.73-1.27, p<0.80); and surgeons who treat fewer black patients (OR 1.58, 95% CI 1.44-1.73, p<0.001) vs surgeons who see more black patients (OR 1.43, 95% CI 1.30-1.57, p<0.0.001). Conclusions Black patients are significantly more likely to receive an amputation than a salvage procedure when presenting with significant peripheral vascular diseases. High procedural volume does not seem to reduce unequal treatment, while diversity of surgeon practice does.

Publisher URL: www.sciencedirect.com/science

DOI: S107275151830019X

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