Vigoda Michael M, Rodríguez Luis I, Wu Eric, Perry Kevin, Duncan Robert, Birnbach David J, Lubarsky David A
Center for Informatics and Perioperative Management, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
Anesth Analg. 2008 Jul;107(1):185-92. doi: 10.1213/01.ane.0000289651.65047.3b.
Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery.
We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital.
Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4% (1346) had CAD. Patients with CAD: Men were more likely to be taking beta-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking beta-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of beta-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for beta-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic beta-blocker therapy (P < 0.0001 for each medication).
Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.
以往基于麻醉信息管理系统的研究主要集中在术中数据分析。回顾术前数据有助于深入了解接受外科手术患者的门诊治疗情况。由于在心脏病患者治疗中已证实存在性别差异，我们推测计划接受择期非心脏手术的冠状动脉疾病（CAD）患者在门诊药物治疗方面也会存在性别差异。
我们分析了2004年1月至2006年6月（30个月）期间，一家市中心医院中因择期非心脏手术前来就诊的门诊CAD患者（有心肌梗死[MI]病史、冠状动脉搭桥手术史、有或无支架置入的血管成形术史、心绞痛）的电子病历。
在麻醉前门诊就诊的21039名门诊患者中，6.4%（1346名）患有CAD。CAD患者：男性更有可能服用β受体阻滞剂（P < 0.002）、他汀类药物（P < 0.0001）、阿司匹林（P < 0.0001）和抗血小板药物（P < 0.04），不过在研究过程中女性使用阿司匹林的趋势有所增加（P < 0.01）。有MI病史的患者：有MI病史的男性更有可能服用β受体阻滞剂（P < 0.0001）和他汀类药物（P < 0.02），尽管在研究过程中女性使用β受体阻滞剂（P < 0.0005）和阿司匹林（P < 0.03）的趋势有所增加。门诊药物使用的季度患病率中β受体阻滞剂最高，阿司匹林最低。如果患者接受慢性β受体阻滞剂治疗，他们更有可能服用他汀类药物、阿司匹林或口服抗血小板药物（每种药物P < 0.0001）。
汇总麻醉管理信息系统数据可提供对手术患者社区护理的流行病学观点。我们发现，CAD患者门诊治疗中以前男性占优的性别差异主要因女性对这些药物使用增加而缩小。尽管如此，尽管有证据支持使用降低风险策略，但我们的患者在标准药物治疗方面仍未得到充分治疗。
