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接受血管内和开放性腹主动脉瘤修复的西班牙裔患者的治疗结果差异。

Disparities in outcomes for Hispanic patients undergoing endovascular and open abdominal aortic aneurysm repair.

作者信息

Williams Timothy K, Schneider Eric B, Black James H, Lum Ying Wei, Freischlag Julie A, Perler Bruce A, Abularrage Christopher J

机构信息

Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA.

出版信息

Ann Vasc Surg. 2013 Jan;27(1):29-37. doi: 10.1016/j.avsg.2012.06.006. Epub 2012 Oct 18.

Abstract

BACKGROUND

Previous studies have demonstrated racial and ethnic disparities associated with the outcomes of abdominal aortic aneurysm (AAA) repair, although little is known about the influence of race and ethnicity on the costs associated with these disparities. The current study was undertaken to examine the influence of race and ethnicity on the outcomes of endovascular (EVAR) and open repair (open AAA) of unruptured AAA and its effect on costs in contemporary practice.

METHODS

The Nationwide Inpatient Sample (2005 to 2008) was queried using ICD-9-CM codes for unruptured AAA (441.4). The primary outcomes were mortality and total hospital charges. Multivariate analyses were performed adjusting for age, gender, race, comorbidities (Charlson index), year, insurance type, and hospital characteristics.

RESULTS

A total of 62,728 patients underwent EVAR and 24,253 patients underwent open AAA. White patients (72%) were more likely to undergo EVAR than Hispanic (69%) or black patients (69%; P = 0.02). On univariate analysis, in-hospital mortality after EVAR was increased in Hispanic patients compared with white patients (1% vs 2%; P = 0.02). There were no differences in mortality after EVAR between white and black patients, and there were no racial or ethnic differences in mortality after open AAA. Hispanic ethnicity remained an independent risk factor for increased mortality after AAA repair on multivariate analysis (RR 1.64; 95% CI [1.05 to 2.57]; P = 0.03). Hispanic ethnicity was associated with increased hospital charges compared with white ethnicity after both EVAR ($108,886 vs $77,748; P < 0.001) and open AAA ($134,356 vs $85,536; P < 0.001) and for black patients after open AAA ($101,168 vs $85,536; P = 0.04).

CONCLUSIONS

Hispanic ethnicity is an independent risk factor for mortality after AAA repair independent of insurance type or hospital characteristics. There were dramatic disparities in hospital costs for Hispanic patients undergoing either EVAR or open AAA and for black patients after open AAA compared with white patients. This observation seems unrelated to length of stay, postoperative complications, and admission status. Further studies are needed to determine whether these disparities extend beyond the primary hospitalization.

摘要

背景

既往研究已证实腹主动脉瘤(AAA)修复结局存在种族和民族差异,尽管种族和民族对这些差异相关成本的影响知之甚少。本研究旨在探讨种族和民族对未破裂AAA的血管内修复(EVAR)和开放修复(开放AAA)结局的影响及其对当代医疗实践中成本的影响。

方法

使用ICD-9-CM编码(441.4)查询全国住院患者样本(2005年至2008年)中的未破裂AAA患者。主要结局为死亡率和住院总费用。进行多变量分析,并对年龄、性别、种族、合并症(Charlson指数)、年份、保险类型和医院特征进行校正。

结果

共有62728例患者接受了EVAR,24253例患者接受了开放AAA修复。白人患者(72%)比西班牙裔(69%)或黑人患者(69%;P = 0.02)更有可能接受EVAR。单变量分析显示,与白人患者相比,西班牙裔患者EVAR术后住院死亡率升高(1%对2%;P = 0.02)。白人患者和黑人患者EVAR术后死亡率无差异,开放AAA术后死亡率也无种族或民族差异。多变量分析显示,西班牙裔仍然是AAA修复术后死亡率增加的独立危险因素(风险比1.64;95%置信区间[1.05至2.57];P = 0.03)。与白人相比,西班牙裔患者在接受EVAR(108886美元对77748美元;P < 0.001)和开放AAA(134356美元对85536美元;P < 0.001)后以及黑人患者接受开放AAA后(101168美元对85536美元;P = 0.04),住院费用均增加。

结论

西班牙裔是AAA修复术后死亡率的独立危险因素,与保险类型或医院特征无关。与白人患者相比,接受EVAR或开放AAA的西班牙裔患者以及接受开放AAA的黑人患者的住院费用存在显著差异。这一观察结果似乎与住院时间、术后并发症和入院状态无关。需要进一步研究以确定这些差异是否超出初次住院范围。

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