RR29. Vascular Repair Followed by Tissue Transfer in War Trauma: Differences in Limb Salvage Rates

Objectives: We compared in-hospital mortality (IHM) and resource utilization among vascular surgical patients at safety net hospitals (SNPHs) with those at nonsafety net hospitals (nSNPHs). Methods: National Inpatient Sample (2005-2011) was queried to identify surgical patients with peripheral arterial disease (PAD), carotid stenosis (CS), and nonruptured abdominal aorta aneurysm (AAA) based on International Classification of Diseases, Ninth Revision codes. The cohort was divided into SNPH and nSNPH groups using the definition of SNPH by the National Association of Public Hospitals. Characteristics, length of stay (LOS), IHM, and median charges (MC) were compared between the groups. Advanced PAD was defined as PAD patients with rest pain or ulceration. Statistical methods included c test (categoric variables), t-test (continuous variables), gamma regression (LOS and MC), and logistic regression to adjust for confounding variables (IHM). Results: We identified 306,438 patients operated for PAD, CS, or AAA (Table). Patients at SNPH were younger, had a higher percentage of female and minority patients, and a higher Elixhauser comorbidity index (P < .001). Nonelective admissions were more common among SNPH patients who presented with more advanced PAD and symptomatic CS. Patients at SNPH had significantly higher LOS, MC, and IHM. For SNPH patients, adjusted odds ratio for mortality was 1.28 higher than at nSNPH (95% confidence interval, 1.13-1.46; P < .001). Conclusions: Vascular surgery patients at SNPH, despite being younger, have higher comorbidities, present more urgently with more advanced vascular disease, and therefore, have costlier care and suffer worse outcome than other cohort. This study suggests an unequal access to preoperative care in these more sociodemographically challenged patients.