种族对急诊腹部手术后院内死亡率的影响：一项使用医院病历统计数据的全国队列研究。

The effect of ethnicity on in-hospital mortality following emergency abdominal surgery: a national cohort study using Hospital Episode Statistics.

作者信息

Vohra R S, Evison F, Bejaj I, Ray D, Patel P, Pinkney T D

机构信息

Academic Department of Surgery, School of Cancer Sciences, University of Birmingham, Birmingham, B15 2TH, UK.

Department of Informatics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.

出版信息

Public Health. 2015 Nov;129(11):1496-502. doi: 10.1016/j.puhe.2015.07.038. Epub 2015 Aug 28.

DOI:10.1016/j.puhe.2015.07.038

PMID:26318618

Abstract

OBJECTIVES

Ethnicity has complex effects on health and the delivery of health care in part related to language and cultural barriers. This may be important in patients requiring emergency abdominal surgery where delays have profound impact on outcomes. The aim here was to test if variations in outcomes (e.g. in-hospital mortality) exist by ethnic group following emergency abdominal surgery.

STUDY DESIGN

Retrospective cohort study using population-level routinely collected administrative data from England (Hospital Episode Statistics).

METHODS

Adult patients undergoing emergency abdominal operations between April 2008 and March 2012 were identified. Operations were divided into: 'major', 'hepatobiliary' or 'appendectomy/minor'. The primary outcome was all cause in-hospital mortality. Univariable and multivariable analysis odds ratios (OR with 95% confidence intervals, CI) adjusting for selected factors were performed.

RESULTS

359,917 patients were identified and 80.7% of patients were White British, 4.7% White (Other), 2.4% Afro-Caribbean, 1.6% Indian, 2.6% Chinese, 3.1% Asian (Other) and 4.9% not known, with crude in-hospital mortality rates of 4.4%, 3.1%, 2.0%, 2.6%, 1.6%, 1.7% and 5.17%, respectively. The majority of patients underwent appendectomy/minor (61.9%) compared to major (20.9%) or hepatobiliary (17.2%) operations (P < 0.001) with an in-hospital mortality of 1.7%, 11.5% and 3.9% respectively. Adjusted mortality was largely similar across ethnic groups except where ethnicity was not recorded (compared to White British patients following major surgery OR 2.05, 95% 1.82-2.31, P < 0.01, hepatobiliary surgery OR 2.78, 95% CI 2.31-3.36, P = 0.01 and appendectomy/minor surgery OR 1.78, 95% 1.52-2.08, P < 0.01).

CONCLUSIONS

Ethnicity is not associated with poorer outcomes following emergency abdominal surgery. However, ethnicity is not recorded in 5% of this cohort and this represents an important, yet un-definable, group with significantly poorer outcomes.

摘要

目的

种族对健康及医疗服务有着复杂的影响，部分原因与语言和文化障碍相关。这对于需要进行急诊腹部手术的患者可能很重要，因为手术延迟会对治疗结果产生深远影响。本研究旨在检验急诊腹部手术后不同种族患者的治疗结果（如住院死亡率）是否存在差异。

研究设计

采用回顾性队列研究，使用从英格兰常规收集的人群水平行政数据（医院事件统计数据）。

方法

确定2008年4月至2012年3月期间接受急诊腹部手术的成年患者。手术分为：“大型”、“肝胆”或“阑尾切除/小型”。主要结局指标为全因住院死亡率。进行单变量和多变量分析，计算调整选定因素后的比值比（OR及95%置信区间CI）。

结果

共确定359,917例患者，其中80.7%为英国白人，4.7%为其他白人，2.4%为非洲加勒比裔，1.6%为印度裔，2.6%为华裔，3.1%为其他亚裔，4.9%种族未知；其粗住院死亡率分别为4.4%、3.1%、2.0%、2.6%、1.6%、1.7%和5.17%。大多数患者接受阑尾切除/小型手术（61.9%），相比之下，大型手术（20.9%）或肝胆手术（17.2%）较少（P < 0.001），其住院死亡率分别为1.7%、11.5%和3.9%。除种族未记录的情况外，各民族调整后的死亡率大致相似（与接受大型手术后的英国白人患者相比OR为2.05，95% 1.82 - 2.31，P < 0.01；肝胆手术后OR为2.78，95% CI 2.31 - 3.36；P = 0.01；阑尾切除/小型手术后OR为1.78，95% 1.52 - 2.08；P < 0.01）。