Disparities in Access to Endovenous Treatment Options in Chronic Lower Extremity Superficial Venous Insufficiency: A National 7-Year Analysis.

OBJECTIVE: The goal of this study was to analyze trends in treatment access for chronic superficial venous disease and to identify disparities in care.

METHODS: This study was a retrospective study and exempt from Institutional Review Board approval. The American College of Surgeon - National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent vein stripping (VS) and endovenous procedures for treatment of chronic superficial venous disease. Endovenous options included radiofrequency ablation (RFA) and laser ablation. Data was available from 2011-2018 and demographic information was extracted for each patient identified by the procedural CPT codes. For all racial and ethnic groups, trend lines were plotted, and relative rate of change was determined within each specified demographic.

RESULTS: There were 21,025 patients included in the analysis. The overall mean age was 54.2 years old, and the majority of patients were female (64.8%). 27.9%, 55.2% and 16.9% patients underwent VS, RFA, and laser ablation, respectively. Patients who received laser ablation were older (p < 0.001). Hispanic ethnicity was associated with significantly lower odds of receiving EVTA over VS (OR = 0.71, 95% CI = 0.64 - 0.78, p < 0.001). American Indian / Alaska Native patients were more likely to receive EVTA over VS (OR = 4.02, 95% CI = 2.48 - 6.86); similarly, Native Hawaiian / Pacific Islander patients were more likely to receive EVTA over VS although this was not statistically significant OR = 1.44, 95% CI = 0.93 - 2.27). On multinomial regression, Hispanic patients were less likely to receive RFA over VS, whereas American Indian / Alaskan Native patients were more likely to receive RFA over VS. In all racial and ethnic groups, the percentage of endovenous procedures increased while vein stripping decreased.

CONCLUSION: Based on a hospital-based dataset, demographic indicators, including age, sex, race, and ethnicity, are associated with differences in endovenous treatments for chronic superficial venous insufficiency suggesting disparities in obtaining minimally invasive treatment options among certain patient groups.