Kelly Gynecologic Oncology Service, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Gynecol Oncol. 2011 Jun 1;121(3):571-6. doi: 10.1016/j.ygyno.2011.02.004. Epub 2011 Feb 26.
To evaluate the association of race and surgical approach for women who underwent surgical treatment for uterine cancer.
The design was a retrospective cohort study of discharge data from nonfederal acute care hospitals in Maryland from 2000 to 2009. Women aged 18 and older who underwent hysterectomy for uterine cancer were included in the study population. The main outcome measure was receipt of lymphadenectomy. Secondary outcomes included receipt of minimally-invasive surgical approach, in-hospital mortality and individual surgeon and individual hospital annual uterine cancer case volume. The independent variable was race. We used logistic regression to calculate odds ratios and confidence intervals for each outcome of interest. Caucasians were the reference group.
Among 5470 women who underwent hysterectomy, 2727 (49.9%) underwent lymphadenectomy and 512 (9.4%) underwent surgery through a minimally-invasive approach. After adjusting for age, payer status and APR-DRG mortality risk score, African-Americans were more likely to be operated on by high-volume surgeons (adjusted OR=1.27, 95% CI: 1.09-1.49) yet were less likely to undergo minimally-invasive surgery (adjusted OR=0.60, 95% CI: 0.45-0.80). For the outcome of lymphadenectomy, there was no significant difference between Caucasians and African-Americans (OR=1.13, 95% CI: 0.98-1.30). There was no association between race and in-hospital mortality or between race and the odds of undergoing surgery at a high-volume hospital.
In this retrospective analysis of uterine cancer patients, race is associated with likelihood of undergoing surgery through a minimally-invasive approach. Further analysis using prospectively collected data with more detail regarding peri-operative parameters is needed to further clarify possible reasons for this disparity.
评估在接受子宫癌手术治疗的女性中，种族与手术方法之间的关联。
这是一项回顾性队列研究，对马里兰州非联邦急性护理医院 2000 年至 2009 年的出院数据进行分析。研究人群为接受子宫癌子宫切除术的年龄在 18 岁及以上的女性。主要结局指标为接受淋巴结切除术。次要结局指标包括微创手术方法的接受情况、住院死亡率以及每位外科医生和每家医院每年的子宫癌病例量。种族为自变量。我们使用逻辑回归计算每个感兴趣结局的优势比和置信区间。白种人作为参照组。
在 5470 名接受子宫切除术的女性中，2727 名（49.9%）接受了淋巴结切除术，512 名（9.4%）接受了微创手术。调整年龄、付款人身份和 APR-DRG 死亡率风险评分后，非裔美国人更有可能由高手术量的外科医生进行手术（调整后的优势比=1.27，95%可信区间：1.09-1.49），但不太可能接受微创手术（调整后的优势比=0.60，95%可信区间：0.45-0.80）。对于淋巴结切除术的结局，白种人和非裔美国人之间没有显著差异（优势比=1.13，95%可信区间：0.98-1.30）。种族与住院死亡率之间或种族与在高手术量医院接受手术的可能性之间没有关联。
在这项对子宫癌患者的回顾性分析中，种族与接受微创手术的可能性相关。需要使用前瞻性收集的数据并进一步详细分析围手术期参数，以进一步阐明这种差异的可能原因。
