Assessing Race and Socioeconomic Status Based Differences in Survival after Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Abstract

<h3>Purpose</h3> Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Race and socioeconomic based disparities in PTE outcomes have not been well studied. <h3>Methods</h3> We retrospectively reviewed all patients who underwent PTE for CTEPH at our institution from June 2009 to July 2019, tracking patient demographic information including self-identified race, preoperative variables, and 5-year mortality. SES was assessed using the zip code-linked Distressed Communities Index, a validated holistic measure of community well-being. Survival was estimated with Kaplan-Meier and compared using the log-rank test. Factors associated with mortality were estimated using Cox proportional hazards analysis. <h3>Results</h3> Of the 235 patients that underwent PTE during the study period, 100 (42.5%) were white and 88 (37.4%) were black. Out of our 47 (20.1%) patients who were not white or black, we had too few patients of other races to analyze. White patients had a higher median age at surgery than black patients (57 vs 52 years, p = 0.043). There was no difference in 5-year mortality after PTE between black and white patients (p = 0.54, Figure 1). SES (HR 0.97, 95% CI [0.94,0.996], p=0.02) was significantly associated with mortality, while race (HR 0.78, 95% CI [.213, 2.891], p=0.78) was not. <h3>Conclusion</h3> SES but not race was not associated with mortality following PTE at our center. However, additional studies with larger sample sizes are warranted.