Jain Ashish K, Kalbaugh Corey A, Farber Mark A, Marston William A, Vallabhaneni Raghuveer
Division of Vascular Surgery, Department of General Surgery, University of North Carolina, Chapel Hill, NC.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
J Vasc Surg. 2014 Nov;60(5):1275-1281. doi: 10.1016/j.jvs.2014.04.069. Epub 2014 Jun 20.
Race and gender have individually been associated with affecting outcomes in vascular interventions. We hypothesized that race and gender stratification would identify variations in outcomes of lower extremity bypass (LEB) procedures.
LEB procedures were identified using Current Procedural Terminology (American Medical Association, Chicago, Ill) codes from the 2011 American College of Surgeons National Surgical Quality Improvement Program database. Individuals of races other than black or white were excluded because of small sample size. Preoperative variables, such as age, demographics, medical comorbidities, and laboratory values, were evaluated across race and gender groups using χ(2), the Student t-test, and least square means testing. Significant predictors were entered into a multivariate logistic regression model. Six primary outcomes were evaluated: major complications, minor complications, 30-day mortality, early graft failure, readmission, and length of stay (LOS).
There were 4518 LEB procedures performed on black (n = 839; male [BM], 56.5%; female [BF], 43.5%) or white (n = 3679; male [WM], 66.4%; female [WF], 33.6%) patients. Black patients were more likely to be younger, diabetic, smokers, functionally dependent, dialysis dependent, and have hypertension, critical limb ischemia, higher creatinine, lower hematocrits, and higher platelet counts. Multivariate analysis revealed no statistically significant gender differences within the white cohort with respect to complications, death, graft failure, or readmission rates. WF and BM had longer LOS than WM (reference group; 4.7 ± 1.9 days and 5.4 ± 2.0 days vs 4.3 ± 2.0 days, respectively; P < .006 and P < .0001) after LEB procedures, but outcomes among these groups did not differ significantly. BF had a longer LOS than WM (5.8 ± 2.0 days vs 4.3 ± 2.0 days; P < .0001) and trended toward higher readmission rates (odds ratio, 1.28; 95% confidence interval, 0.97-1.70; P = .08). BF had a higher risk of early graft failure than WM (odds ratio, 2.90; 95% confidence interval, 1.52-5.49; P = .001).
BF had higher early graft failure and LOS compared with WM. WF and BM also had increased LOS compared with WM. Race-gender stratification may predict outcomes in patients undergoing LEB procedures that may not be predicted by gender or race alone. Further studies using this stratification methodology may provide better insight into optimal therapeutic strategies and preventative measures for these patient subgroups. Investigation into causes of increased LOS in black patients and increased graft failure in BF may help improve outcomes.
种族和性别各自都与血管介入治疗的结果有关。我们推测，种族和性别分层会发现下肢旁路移植术（LEB）的结果存在差异。
使用2011年美国外科医师学会国家外科质量改进计划数据库中的当前操作术语（美国医学协会，伊利诺伊州芝加哥）编码来识别LEB手术。由于样本量小，排除了非黑种人或白种人的个体。使用χ²检验、学生t检验和最小二乘均值检验对种族和性别组的术前变量，如年龄、人口统计学、合并症和实验室值进行评估。将显著预测因素纳入多变量逻辑回归模型。评估了六个主要结果：主要并发症、次要并发症、30天死亡率、早期移植物失败、再入院率和住院时间（LOS）。
对黑人（n = 839；男性[BM]，56.5%；女性[BF]，43.5%）或白人（n = 3679；男性[WM]，66.4%；女性[WF]，33.6%）患者进行了4518例LEB手术。黑人患者更可能较年轻、患有糖尿病、吸烟、功能依赖、依赖透析，并有高血压、严重肢体缺血、肌酐较高、血细胞比容较低和血小板计数较高。多变量分析显示，在白人队列中，性别在并发症、死亡、移植物失败或再入院率方面没有统计学上的显著差异。LEB手术后，WF和BM的住院时间比WM长（参照组；分别为4.7±1.9天和5.4±2.0天，而WM为4.3±2.0天；P <.006和P <.0001），但这些组之间的结果没有显著差异。BF的住院时间比WM长（5.8±2.0天对4.3±2.0天；P <.0001），且再入院率有升高趋势（比值比，1.28；95%置信区间，0.97 - 1.70；P =.08）。BF早期移植物失败的风险高于WM（比值比，2.90；95%置信区间，1.52 - 5.49；P =.001）。
与WM相比，BF的早期移植物失败率和住院时间更高。与WM相比，WF和BM的住院时间也更长。种族 - 性别分层可能预测接受LEB手术患者的结果，而单独的性别或种族可能无法预测。使用这种分层方法的进一步研究可能会更好地洞察这些患者亚组的最佳治疗策略和预防措施。对黑人患者住院时间延长和BF移植物失败增加的原因进行调查可能有助于改善结果。
