Dean Peter N, McHugh Kimberly E, Conaway Mark R, Hillman Diane G, Gutgesell Howard P
Division of Cardiology, Children's National Medical Center, 111 Michigan Avenue, Washington, DC, 20010-2970, USA,
Pediatr Cardiol. 2013;34(8):1829-36. doi: 10.1007/s00246-013-0723-3. Epub 2013 May 31.
Information is limited regarding the effect of race, ethnicity, and gender on the outcomes of the three palliative procedures for hypoplastic left heart syndrome (HLHS). This study examined the effects of race, ethnicity, gender, type of admission, and surgical volume on in-hospital mortality associated with palliative procedures for HLHS between 1998 and 2007 using data from the University HealthSystem Consortium. According to the data, 1,949 patients underwent stage 1 palliation (S1P) with a mortality rate of 29 %, 1,279 patients underwent stage 2 palliations (S2P) with a mortality rate of 5.4 %, and 1,084 patients underwent stage 3 palliation (S3P) with a mortality rate of 4.1 %. The risk factors for increased mortality with S1P were black and "other" race, smaller surgical volume, and early surgical era. The only risk factors for increased mortality with S2P were black race (11 % mortality; odds ratio [OR], 3.19; 95 % confidence interval [CI] 1.69-6.02) and Hispanic ethnicity (11 % mortality; OR 3.30; 95 % CI 1.64-6.64). For S2P, no racial differences were seen in the top five surgical volume institutions, but racial differences were seen in the non-top-five surgical volume institutions. Mortality with S1P was significantly higher for patients discharged after birth (37 vs 24 %; p = 0.004), and blacks were more likely to be discharged after birth (12 vs 5 % for all other races; p < 0.001). No racial differences with S3P were observed. The risk factors for increased mortality at S1P were black and "other" race, smaller surgical volume, and early surgical era. The risk factors for increased in-hospital mortality with S2P were black race and Hispanic ethnicity.
关于种族、民族和性别对左心发育不全综合征（HLHS）三种姑息治疗手术结果的影响，相关信息有限。本研究利用大学卫生系统联盟的数据，调查了1998年至2007年间种族、民族、性别、入院类型和手术量对HLHS姑息治疗手术相关住院死亡率的影响。根据数据，1949例患者接受了一期姑息治疗（S1P），死亡率为29%；1279例患者接受了二期姑息治疗（S2P），死亡率为5.4%；1084例患者接受了三期姑息治疗（S3P），死亡率为4.1%。S1P死亡率增加的风险因素为黑人及“其他”种族、手术量较小和手术早期。S2P死亡率增加的唯一风险因素是黑人种族（死亡率11%；比值比[OR]，3.19；95%置信区间[CI] 1.69 - 6.02）和西班牙裔民族（死亡率11%；OR 3.30；95% CI 1.64 - 6.64）。对于S2P，前五名手术量机构中未观察到种族差异，但在非前五名手术量机构中观察到种族差异。出生后出院的患者S1P死亡率显著更高（37%对24%；p = 0.004），且黑人更有可能出生后出院（所有其他种族为5%，黑人为12%；p < 0.001）。未观察到S3P的种族差异。S1P死亡率增加的风险因素为黑人及“其他”种族、手术量较小和手术早期。S2P住院死亡率增加的风险因素为黑人种族和西班牙裔民族。
