• Latha Panchap, Seyed A Safavynia, Virginia Tangel, and Robert S White.
• Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
• J. Cardiothorac. Vasc. Anesth. 2020 Jul 1; 34 (7): 1836-1845.

ObjectivesSeveral studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures.DesignRecords of adults from 2007 to 2014 were retrospectively identified, and patients with appropriate International Classification of Diseases Ninth Revision Clinical Modification codes for carotid endarterectomy or carotid artery stenting were identified. Primary outcomes were unadjusted rates and adjusted odds ratios (aORs) of postoperative in-hospital mortality, stroke, combined stroke/mortality, and cardiovascular complications.SettingData were sourced from the State Inpatient Databases data from California, Florida, Kentucky, Maryland, and New York during the years 2007 to 2014.ParticipantsPatients undergoing carotid revascularization procedures.InterventionsThe effects of race and insurance status as independent variables and as effect modifiers on postoperative outcomes.Measurements And Main ResultsMultivariable logistic regression models were used to examine the associations between race and/or insurance status with respect to study outcomes. Race, but not payer status, was significantly associated with adverse outcomes after carotid artery procedures, with blacks, Hispanics, and other non-Caucasian races demonstrating a significantly greater risk of postoperative stroke and mortality (aOR range 1.24-1.59). This relationship persisted even when stratified by procedure type (aOR range 1.25-1.56) and symptomatology (aOR range 1.51-1.63).ConclusionsThese results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.Copyright © 2019 Elsevier Inc. All rights reserved.

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