Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Anesthesiology. 2013 Jul;119(1):43-51. doi: 10.1097/ALN.0b013e31829101de.
Using Pennsylvania Medicare claims from 1995 to 1996, the authors previously reported that anesthesia procedure length appears longer in blacks than whites. In a new study using a different and larger data set, the authors now examine whether body mass index (BMI), not available in Medicare claims, explains this difference. The authors also examine the relative contributions of surgical and anesthesia times.
The Obesity and Surgical Outcomes Study of 47 hospitals throughout Illinois, New York, and Texas abstracted chart information including BMI on elder Medicare patients (779 blacks and 14,596 whites) undergoing hip and knee replacement and repair, colectomy, and thoracotomy between 2002 and 2006. The authors matched all black Medicare patients to comparable whites and compared procedure lengths.
Mean BMI in the black and white populations was 30.24 and 28.96 kg/m, respectively (P<0.0001). After matching on age, sex, procedure, comorbidities, hospital, and BMI, mean white BMI in the comparison group was 30.1 kg/m (P=0.94). The typical matched pair difference (black-white) in anesthesia (induction to recovery room) procedure time was 7.0 min (P=0.0019), of which 6 min reflected the surgical (cut-to-close) time difference (P=0.0032). Within matched pairs, where the difference in procedure times was greater than 30 min between patients, blacks more commonly had longer procedure times (Odds=1.39; P=0.0008).
Controlling for patient characteristics, BMI, and hospital, elder black Medicare patients experienced slightly but significantly longer procedure length than their closely matched white controls. Procedure length difference was almost completely due to surgery, not anesthesia.
作者曾使用 1995 年至 1996 年宾夕法尼亚州的医疗保险索赔数据报告称，黑人的麻醉程序时长比白人长。在一项使用不同且更大数据集的新研究中，作者现在检查身体质量指数（BMI）是否可以解释这种差异，BMI 在医疗保险索赔中不可用。作者还检查了手术和麻醉时间的相对贡献。
伊利诺伊州、纽约州和德克萨斯州的 47 家医院的肥胖和手术结果研究（Obesity and Surgical Outcomes Study），对 2002 年至 2006 年间接受髋关节和膝关节置换和修复、结肠切除术和开胸术的老年医疗保险患者（779 名黑人患者和 14596 名白人患者）的图表信息进行了摘录，包括 BMI。作者将所有黑人医疗保险患者与可比的白人患者相匹配，并比较了手术程序的长度。
黑人患者和白人患者的平均 BMI 分别为 30.24kg/m2 和 28.96kg/m2（P<0.0001）。在年龄、性别、手术、合并症、医院和 BMI 相匹配后，对照组白人患者的平均 BMI 为 30.1kg/m2（P=0.94）。麻醉（诱导至恢复室）程序时间的典型匹配对差异（黑人-白人）为 7.0 分钟（P=0.0019），其中 6 分钟反映了手术（切口至关闭）时间的差异（P=0.0032）。在匹配对中，如果患者之间的手术时间差异超过 30 分钟，则黑人患者更常见手术时间较长（比值比=1.39；P=0.0008）。
在控制患者特征、BMI 和医院后，老年黑人医疗保险患者的手术程序长度略长，但明显长于其密切匹配的白人对照组。手术程序长度的差异几乎完全是由于手术，而不是麻醉。
