SS08 - Socioeconomic Status Not Associated with Worse Outcomes After Open Lower Extremity Revascularization

Objectives: Prior research has shown that socioeconomic status (SES) is correlated with higher rates of diabetes, peripheral vascular disease, and amputation. We sought to determine whether socioeconomic status or insurance type increases the risk of mortality, major adverse limb event (MALE), or hospital length of stay (LOS) following open lower extremity revascularization.

Methods: We conducted a retrospective analysis of a prospectively maintained database of patients who underwent open lower extremity revascularization at a single tertiary care center from January 2011 to March 2017 (N=542). Socioeconomic status was determined using state area deprivation index (ADI), a validated metric determined by income, education, employment, and housing quality by census block group. In patients receiving revascularization procedures on both limbs, each limb was treated individually for analysis. We performed a multivariate analysis of the association between ADI and insurance type with mortality, MALE, and LOS using Cox proportional hazard models, including confounding variables such as age, gender, smoking status, body mass index (BMI), hyperlipidemia, hypertension, and diabetes. The cohort with an ADI of 1, meaning least deprived, and the Medicare cohort were used for reference. P-values < 0.05 were considered statistically significant.

Results: Of 542 patients reviewed, 245 patients undergoing surgery had complete data and were included. Controlling for age, gender, smoking status, body mass index (BMI), hyperlipidemia, hypertension, and diabetes, socioeconomic status was not an independent predictor of mortality (Table I, P=0.974), MALE (P=0.989), or hospital length of stay (P=0.325). Controlling for the same confounders, insurance type was not independently correlated with mortality (Table II, P=0.164) or MALE (P=0.743). Private insurance was associated with significantly longer hospital stays (P=0.004).

Conclusions: This study suggests that socioeconomic status does not correlate with increased risk of mortality or MALE in patients undergoing open lower extremity revascularization. While insurance type did not impact risk of mortality or MALE, those with private insurance may have longer hospital stays following surgery. These findings suggest that individuals undergoing open lower extremity revascularization at this single tertiary care center received similar care regardless of their SES or insurance type. Further study is warranted to determine the factors that led to these findings, including whether individuals with lower SES may be presenting too late for revascularization and instead undergo primary amputation.