种族对单心室先天性心脏病 Glenn 和 Fontan 手术时机的影响。

Effect of race on the timing of the Glenn and Fontan procedures for single-ventricle congenital heart disease.

机构信息

Department of Pediatric Critical Care, Children's Hospital of Nevada, Las Vegas, NV, USA.

出版信息

Pediatr Crit Care Med. 2012 Mar;13(2):174-7. doi: 10.1097/PCC.0b013e3182231862.

DOI:10.1097/PCC.0b013e3182231862

PMID:21666532

Abstract

OBJECTIVE

Disparities in health care have been documented between different racial groups in the United States. We hypothesize that there will be racial variance in the timing of the Glenn and Fontan procedures for children with single-ventricle physiology.

DESIGN AND SETTING

We performed a retrospective review of a national pediatric intensive care unit database (Virtual PICU Performance System, LLC).

PATIENTS

Children with hypoplastic left heart syndrome, tricuspid atresia, and common ventricle, admitted from January 2006 to July 2008, were included. Data included race, weight, age, medical length of stay, Paediatric Index of Mortality 2 score, and survival.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There were 423 patients from 29 hospitals. The study population was 7.6% black, 13.0% Hispanic, 59.8% white, 9.2% "other," and 11.6% had missing racial/ethnic information. Diagnoses included 255 patients with hypoplastic left heart syndrome, 91 with tricuspid atresia, and 77 with common ventricle. The median age for the Glenn procedure (n = 205) was 5.5 months (interquartile range, 4.6-7.0 months) and 39.7 months (interquartile range, 32.4-50.6 months) for the Fontan procedure (n = 218). There was no difference between the median age at the time of the Glenn or Fontan procedures between the different racial/ethnic groups (p = .65 and p = .16, respectively). The medical length of intensive care unit stay for patients receiving the Glenn and Fontan procedures was 3.7 days (interquartile range, 1.9-6.1 days) and 3.7 days (interquartile range, 1.9-6.8 days), respectively. There were no differences in medical length of intensive care unit stay for the Glenn procedure between the different racial/ethnic groups (p = .21). Hispanic patients had a longer medical length of intensive care unit stay (6.3 days; interquartile range, 3.1-9.9 days) than white patients (2.9 days; interquartile range, 1.8-5.3 days) for the Fontan procedure (p = .008).

CONCLUSION

The timing of single-ventricle palliative procedures was not affected by race/ethnicity.

摘要

目的

在美国，不同种族群体之间的医疗保健差异已有记录。我们假设，对于单心室生理的儿童，Glenn 和 Fontan 手术的时机存在种族差异。

设计和设置

我们对全国儿科重症监护病房数据库（Virtual PICU Performance System，LLC）进行了回顾性研究。

患者

2006 年 1 月至 2008 年 7 月期间收治的患有左心发育不全综合征、三尖瓣闭锁和共同心室的患儿。数据包括种族、体重、年龄、医疗住院时间、儿科死亡率 2 评分和存活率。

干预措施

无。

测量和主要结果

共有 29 家医院的 423 名患者。研究人群中 7.6%为黑人，13.0%为西班牙裔，59.8%为白人，9.2%为“其他”，11.6%的患者种族/民族信息缺失。诊断包括 255 例左心发育不全综合征患者，91 例三尖瓣闭锁患者和 77 例共同心室患者。205 例接受 Glenn 手术患者的中位年龄为 5.5 个月（四分位间距，4.6-7.0 个月），218 例接受 Fontan 手术患者的中位年龄为 39.7 个月（四分位间距，32.4-50.6 个月）。不同种族/民族组在 Glenn 或 Fontan 手术的中位年龄之间无差异（p =.65 和 p =.16）。接受 Glenn 和 Fontan 手术的患者的重症监护病房住院医疗时间分别为 3.7 天（四分位间距，1.9-6.1 天）和 3.7 天（四分位间距，1.9-6.8 天）。不同种族/民族组之间 Glenn 手术的重症监护病房住院医疗时间无差异（p =.21）。接受 Fontan 手术的西班牙裔患者的重症监护病房住院医疗时间（6.3 天；四分位间距，3.1-9.9 天）长于白人患者（2.9 天；四分位间距，1.8-5.3 天）（p =.008）。