Schneider Eric B, Calkins Keri L, Weiss Matthew J, Herman Joseph M, Wolfgang Christopher L, Makary Martin A, Ahuja Nita, Haider Adil H, Pawlik Timothy M
Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Surgery. 2014 Sep;156(3):528-37. doi: 10.1016/j.surg.2014.04.004. Epub 2014 Jun 24.
Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined.
Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS.
Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P < .001) and by medium- to high-volume surgeons (OR 1.62, P < .001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P = .250). After adjustment, black (OR 1.36, P = .010) and Hispanic (OR 1.68, P < .001) patients were more likely to have a greater LOS after PD.
Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients.
包括胰十二指肠切除术（PD）在内的各种手术中，已证实存在基于种族的手术发病率和死亡率差异。基于种族的住院时间（LOS）差异，尤其是与外科医生和医院层面的医疗服务提供者数量相关的差异，仍未得到明确界定。
利用2003 - 2009年全国住院患者样本，我们确定了外科医生和医院特定年份的PD手术量，并将其分为三分位数。对患者的种族（白人、黑人或西班牙裔）、年龄、性别和合并症进行了检查。计算住院时间中位数，并使用多变量逻辑回归分析与住院时间延长相关的因素。
在4319名符合条件的个体中，3502名（81.1%）为白人，423名（9.8%）为黑人，394名（9.1%）为西班牙裔。总体住院时间中位数为12天（范围0 - 234天）。外科医生的年手术量中位数为8例（四分位间距[IQR]为2 - 19例；范围为1 - 54例）。医院的年手术量范围为1至129例（中位数为19例；IQR为7 - 55例）。与黑人或西班牙裔患者相比，白人患者更有可能在手术量中等至高的医院接受治疗（优势比[OR]为1.53，P <.001），并由手术量中等至高的外科医生进行手术（OR为1.62，P <.001）。PD手术后，白人、黑人和西班牙裔患者的院内死亡率相似（分别为5.1%、5.7%和7.2%，P =.250）。调整后，黑人（OR为1.36，P =.010）和西班牙裔（OR为1.68，P <.001）患者在PD手术后更有可能有更长的住院时间。
与白人患者相比，黑人和西班牙裔PD患者在手术量较高的医院接受治疗以及由手术量较高的外科医生进行手术的可能性较小。黑人和西班牙裔患者在PD后的死亡率和住院时间比例更高。
