Disparities in Limb-Saving Surgery Persist Among Black Patients With Peripheral Artery Disease

Background Peripheral artery disease (PAD) affects many individuals in the United States and imposes substantial healthcare costs. Chronic limb-threatening ischemia (CLTI) is a severe form of PAD. This study evaluates racial disparities in access to different treatment approaches for CLTI, hypothesizing that patients of Black self-reported race may experience significant barriers to receiving open surgical bypass. Methods In this retrospective study, data were analyzed from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. All recorded cases of surgical bypass, endovascular revascularization, or amputation below the knee for the treatment of CLTI from 2012 to 2021 were included in this analysis. Propensity score matching and univariate analyses were conducted to evaluate the association between self-identified race, treatment access, and clinical outcomes. Results A total of 42,889 cases of CLTI were identified. Black patients were less likely to undergo open surgery (5,000 (38.4%) vs. 13,981 (47.7%); p < 0.001) and more likely to undergo endovascular therapy (6,402 (49.2%) vs. 13,299 (45.3%); p < 0.001) and amputation (1,621 (12.4%) vs. 2,060 (7.0%); p < 0.001). Black patients also experienced higher rates of postoperative complications, including cardiac arrest, deep vein thrombosis, sepsis, myocardial infarction, ventilator dependence >48 hours, reoperation, 30-day mortality, and 30-day readmission. After propensity score matching and logistic regression, Black self-reported race remained an independent predictor of endovascular revascularization and amputation rather than open bypass. Conclusions This study revealed a significant racial disparity in access to open bypass among self-identified Black CLTI patients. Patients of Black self-reported race were more likely to experience postoperative complications or reoperation within 30 days following the operation. Although an endovascular technique may reduce 30-day complications, recent literature indicates that open bypass may improve long-term postoperative outcomes. These results highlight the need for further investigation to identify and mitigate barriers contributing to disparities.