Hernandez Roland A, Hevelone Nathanael D, Lopez Lenny, Finlayson Samuel R G, Chittenden Eva, Cooper Zara
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Am J Surg. 2015 Jul;210(1):52-8. doi: 10.1016/j.amjsurg.2014.08.025. Epub 2014 Oct 13.
Although various studies have documented increased life-sustaining treatments among racial minorities in medical patients, whether similar disparities exist in surgical patients is unknown.
A retrospective cohort study using the Nationwide Inpatient Sample (2006 to 2011) examining patients older than 39 years who died after elective colectomy was performed. Primary predictor variable was race, and main outcome was the use of life-sustaining treatment.
In univariate analysis, significant differences existed in use of cardiopulmonary resuscitation (CPR; black, 35.9%; Hispanic, 29.0%; other, 24.5%; white, 11.7%; P = .002) and reintubation (Hispanic, 75.0%; other, 69.0%; black, 52.3%; white, 45.2%; P = .01). In multivariate analysis, black (odds ratio [OR], 3.67; P = .01) and Hispanic (OR, 4.21; P = .03) patients were more likely to have undergone CPR, and Hispanic patients (OR, 4.24; P = .01) were more likely to have been reintubated (reference: white).
Blacks and Hispanics had increased odds of experiencing CPR, and Hispanics were more likely to have been reintubated before death after a major elective operation. These variations may imply worse quality of death and increased associated costs.
尽管多项研究记录了内科患者中少数族裔接受维持生命治疗的情况有所增加，但外科患者中是否存在类似差异尚不清楚。
一项回顾性队列研究，使用全国住院患者样本（2006年至2011年），研究39岁以上接受择期结肠切除术后死亡的患者。主要预测变量是种族，主要结局是维持生命治疗的使用情况。
在单因素分析中，心肺复苏（CPR）的使用存在显著差异（黑人，35.9%；西班牙裔，29.0%；其他，24.5%；白人，11.7%；P = 0.002）以及再次插管情况（西班牙裔，75.0%；其他，69.0%；黑人，52.3%；白人，45.2%；P = 0.01）。在多因素分析中，黑人（比值比[OR]，3.67；P = 0.01）和西班牙裔患者（OR，4.21；P = 0.03）接受心肺复苏的可能性更高，西班牙裔患者（OR，4.24；P = 0.01）再次插管的可能性更高（参照：白人）。
黑人和西班牙裔接受心肺复苏的几率增加，西班牙裔在大的择期手术后死亡前再次插管的可能性更高。这些差异可能意味着死亡质量更差且相关成本增加。
