b'Scientific Session Abstracts SUNDAY APRIL 21, 2024 40: DISPARITIES IN ACCESS TO REVASCULARIZATION PRIOR TO AMPUTATION AND THEIR IMPACT ON SURVIVALNadin Elsayed MD 1 , Ahmed AbouZamzam MD2, Cassius Iyad Ochoa Chaar MD3, Elsie Ross MD, Mahmoud B. Malas MD MHS11 University of California San Diego, 2 Loma Linda University Medical Center,3 Yale UniversityBackground: Discrepancies persist regarding the prevalence, treatment, and outcomes in managing peripheral arterial disease (PAD). Patients presenting with critical limb-threatening ischemia (CLTI) are at high risk for amputation. Hence, a prompt revascularization attempt is indicated for limb salvage. We aim to determine if a disparity exists in access to revascularization before major amputation.Methods: We performed a retrospective analysis of all CLTI patients who underwent major amputation in the VQI Database from 2012-2023. Multivariable logistic regression was used to select variables predicting disparities. Hosmer-Lemeshow goodness of fit (GOF) testing was used to assess model fit. The Area under ROC curve (AUC) was used to evaluate model accuracy.Results: 11,025 patients were included, 4,636 (42.05%) had no prior revascularization attempts. Patients undergoing primary amputation were more likely to be non-white (49.31% vs 43.05%, P0.001), to have diabetes, CKD, or dialysis, and less likely to be on preoperative medications. Factors associated with lower odds of prior revascularization included high volume surgeon (OR: 0.77, 95%CI(0.68-0.87), P0.001), CHF (OR: 0.84, 95%CI(0.74-0.94), P=0.002), diabetes (OR:0.84, 95%CI (0.76-0.93), P=0.001), CKD (OR: 0.87, 95%CI(0.79-0.97), P=0.012), ASA class IV-V (OR: 0.86, 95%CI(0.78-0.95), P=0.003), presenting with tissue loss (OR: 0.42, 95%CI(0.36-0.50), P0.001), and living in a socially disadvantaged area with ADI of 4 or higher.Factors associated with higher odds of prior revascularization included female gender (OR: 1.29, 95%CI(1.17-1.43), P0.001), prior ipsilateral amputation (OR: 1.14, 95%CI(1.10-1.19), P0.001), hypertension (OR: 1.25, 95%CI(1.07-1.46), P=0.005), being on preoperative aspirin, statin (OR: 1.40, 95%CI(1.25- 1.56), P0.001), P2Y12 inhibitor (OR: 2.64, 95%CI(2.37-2.96), P0.001), and anticoagulants, being a current or former smoker, and having Medicare Advantage vs Medicaid insurance(Figure 1). The AUC for the model was 0.7273 and the GOF was 0.3421 indicating good model accuracy and fitness. Patients with prior revascularization attempts had lower 5-year mortality (40.67% vs 47.04%, P0.001)(aHR: 0.86, 95%CI(0.79-0.94), P=0.001)(Figure 2).42 NDANNUAL MEETING|APRIL 1921, 2024|OCEANSIDE, CA 99'