Analyzing the impact of socioeconomic deprivation on patient outcomes in lower extremity bypass surgery

Background Surgical bypass remains an essential treatment option for critical limb-threatening ischemia (CLTI) or severe claudication in many patients with advanced disease. Socioeconomic status has emerged as a determinant of health outcomes in various surgical specialties, yet its specific role in peripheral bypass outcomes remains understudied. Here, we examine the influence that area deprivation has on lower extremity bypass outcomes. Materials and Methods From a prospectively maintained, multi-hospital registry, we identified patients aged 18 years or older who underwent first-time lower extremity bypass (LEB) procedures at the University of Texas Medical Branch (UTMB) hospitals between October 2012 and August 2024. Patient addresses, including nine-digit ZIP codes, were matched to census-tract-level Area Deprivation Index (ADI) scores obtained from the University of Wisconsin Neighborhood Atlas. The ADI quantifies socioeconomic deprivation based on variables such as income, education, and employment. Patients were stratified into ADI quartiles (Q1–Q4), and outcomes were analyzed both by quartile and as a continuous variable. The primary outcomes were graft failure, defined by clinical notes and major amputations, which were assessed using multivariable logistic regression models adjusted for age, sex, race, comorbidities, and first-time procedure status. Results were reported as odds ratios (OR) and 95% confidence intervals (CI). Secondary outcomes included complication rates at 3, 6, and 12 months across ADI groups. Survival analyses were performed to evaluate long-term complication-free survival in relation to ADI quartiles, while angioplasty was considered a secondary intervention to maintain graft patency. Results Among the 128 patients undergoing first-time lower extremity bypass, the median age was 62 years (interquartile range 25–98), with 89% male, 61% identifying as non-Hispanic (NH) White, 27% as NH Black, and 25% as Hispanic. The national median ADI score among patients was 64 (20–97). Notably, patients in the highest ADI quartile (Q4: ADI 78–97) were over eight times more likely to be NH Black (51.6%) compared to those in the least deprived quartile (Q1: 6.5%; p=0.0002). A high prevalence of comorbidities was observed across ADI groups. Tobacco use was universal (100%) among patients who experienced graft failure and major amputation. Higher ADI was associated with more advanced disease at presentation, as patients in Q4 exhibited significantly higher rates of multi-stage disease (56%), while those in moderate ADI groups (Q2–Q3) more frequently presented with isolated Stage 2 rest pain or Stage 3 tissue loss or wounds (p