美国择期行腹外疝修补术患者和医院特征对结局的影响。
Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States.
机构信息
Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA,
出版信息
Hernia. 2013 Oct;17(5):639-45. doi: 10.1007/s10029-013-1088-5. Epub 2013 Apr 24.
PURPOSES
Our ability to predict complications of ventral hernia repairs (VHR) are inadequate. Although impact of patient comorbidities and hospital characteristics on outcomes of several surgical procedures has been reported, such analysis on elective herniorrhaphy has not been performed to date. We hypothesized that obesity and diabetes as well as socioeconomic factors would have deleterious outcomes on elective VHR.
METHODS
Analysis of 2004-2008 Nationwide Inpatient Sample database. Main outcome measures included wound/systemic morbidity, length of stay, discharge status, and in-hospital mortality. Bivariate and multivariate analyses were performed to assess influence of diabetes, obesity, patient socioeconomic factors, and hospital characteristics on the outcomes of VHR.
RESULTS
A total of 78,348 adults undergoing elective VHR were analyzed. Obesity had significant risks for cardiopulmonary complications and prolonged hospitalization. Diabetics were more likely to have delayed wound healing. Hispanic patients had significantly higher rates of pulmonary complications and mortality. As compared to private insurance patients, Medicaid and Medicare patients had significantly higher odds of complications, prolonged hospitalization, non-routine discharge, and mortality.
CONCLUSION
Obesity and diabetes appear to be significant predictors of morbidity in patients undergoing elective VHR. Alarmingly, Medicare/Medicaid patients not only had the highest rates of wound/systemic complications but also the highest post-operative mortality. For the first time, we demonstrated that in addition to comorbidities, both patient socioeconomic factors and hospital characteristics appear to be major determinants of post-herniorrhaphy complications and mortalities. Improved health maintenance and reduction in income-related disparities in health care delivery may be paramount in improving outcomes of VHR in the United States.
目的
我们预测腹疝修补术（VHR）并发症的能力不足。尽管已经报道了患者合并症和医院特征对几种手术结果的影响，但迄今为止，尚未对择期疝修补术进行此类分析。我们假设肥胖和糖尿病以及社会经济因素会对择期 VHR 产生不良后果。
方法
分析了 2004-2008 年全国住院患者样本数据库。主要观察指标包括伤口/全身发病率、住院时间、出院状态和住院死亡率。进行了单变量和多变量分析，以评估糖尿病、肥胖、患者社会经济因素和医院特征对 VHR 结果的影响。
结果
共分析了 78348 例接受择期 VHR 的成年人。肥胖与心肺并发症和住院时间延长有显著风险。糖尿病患者更容易出现伤口愈合延迟。西班牙裔患者肺部并发症和死亡率明显较高。与私人保险患者相比，医疗补助和医疗保险患者并发症、住院时间延长、非常规出院和死亡率的几率显著更高。
结论
肥胖和糖尿病似乎是择期 VHR 患者发病率的重要预测因素。令人震惊的是，医疗保险/医疗补助患者不仅伤口/全身并发症发生率最高，而且术后死亡率也最高。我们首次证明，除了合并症外，患者的社会经济因素和医院特征似乎也是疝修补术后并发症和死亡率的主要决定因素。改善健康维护和减少与收入相关的医疗保健提供方面的差距，可能对改善美国 VHR 的结果至关重要。
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