Department of Surgery, Yale University School of Medicine, New Haven, Conn 06510, USA.
J Vasc Surg. 2013 May;57(5):1325-30. doi: 10.1016/j.jvs.2012.10.131. Epub 2013 Jan 30.
Racial disparities in the outcomes of patients undergoing carotid endarterectomy (CEA) have been reported. We sought to examine the contemporary relationship between race and outcomes and to report postdischarge events after CEA.
The American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were reviewed to identify all CEAs performed from 2005 to 2010 by vascular surgeons. The influence of race on outcomes was examined. Multivariate analysis was performed using variables found to be significant on bivariate analysis. The primary outcomes were stroke and mortality. Secondary outcomes were other 30-day complications, including postdischarge events.
CEA was performed on 29,114 white patients (95.7%) and on 1316 black patients (4.3%); the overall stroke and mortality rates were 1.65% and 0.7%, respectively. The stroke rate was 1.6% for whites and 2.5% blacks (P = .009). The 30-day mortality rate was 0.7% for whites and 1.4% for blacks (P = .002). There was a longer operating time (P < .001) and total length of stay (P < .001), more postoperative pneumonias (P = .049), unplanned intubations (P < .001), ventilator dependence (P < .001), cardiac arrests (P < .001), bleeding requiring transfusions (P = .024), and reoperations within 30 days (P = .021) among black patients. Multivariate logistic regression modeling identified black race as an independent risk factor for 30-day mortality (odds ratio, 1.9; P = .007). Black patients also had a greater proportion of in-hospital deaths than white patients (73.7% vs 43.1%; P = .01). There was no between-group difference in the rate of postdischarge strokes. Thirty-six percent of all strokes occurred after discharge at a mean of 8.3 days, and 54.3% of deaths occurred after discharge at a mean of 11 days.
Black race is an independent risk factor for 30-day mortality after CEA. A significant proportion of strokes and deaths occur after discharge in both racial groups evaluated.
已有研究报道，在颈动脉内膜切除术（CEA）患者的结局方面存在种族差异。我们旨在研究当代种族与结局之间的关系，并报告 CEA 后的出院后事件。
我们查阅美国外科医师学会国家外科质量改进计划参与者使用数据库，以确定 2005 年至 2010 年期间血管外科医生实施的所有 CEA。研究分析了种族对结局的影响。采用多元分析方法分析了单变量分析中发现的有统计学意义的变量。主要结局为卒中和死亡率。次要结局为其他 30 天并发症，包括出院后事件。
29114 例白人患者（95.7%）和 1316 例黑人患者（4.3%）接受了 CEA；总的卒中和死亡率分别为 1.65%和 0.7%。白人患者的卒中发生率为 1.6%，黑人患者为 2.5%（P=0.009）。白人患者 30 天死亡率为 0.7%，黑人患者为 1.4%（P=0.002）。黑人患者的手术时间较长（P<0.001），总住院时间较长（P<0.001），术后肺炎发生率较高（P=0.049），计划性插管较多（P<0.001），呼吸机依赖较多（P<0.001），心脏骤停较多（P<0.001），需要输血的出血较多（P=0.024），30 天内再手术较多（P=0.021）。多元逻辑回归模型确定黑人种族是 30 天死亡率的独立危险因素（比值比，1.9；P=0.007）。黑人患者的院内死亡率也高于白人患者（73.7% vs 43.1%；P=0.01）。两组间出院后卒中的发生率无差异。所有卒中有 36%发生在出院后，平均时间为 8.3 天，所有死亡中有 54.3%发生在出院后，平均时间为 11 天。
黑人种族是 CEA 后 30 天死亡率的独立危险因素。在评估的两个种族群体中，都有相当比例的卒中和死亡发生在出院后。
