大型手术围手术期结局的种族/族裔差异：来自国家外科质量改进计划的结果
Racial/Ethnic Disparities in Perioperative Outcomes of Major Procedures: Results From the National Surgical Quality Improvement Program.
作者信息
Ravi Praful, Sood Akshay, Schmid Marianne, Abdollah Firas, Sammon Jesse D, Sun Maxine, Klett Dane E, Varda Briony, Peabody James O, Menon Mani, Kibel Adam S, Nguyen Paul L, Trinh Quoc-Dien
机构信息
*Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK †Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI ‡Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA §Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada ¶Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Ann Surg. 2015 Dec;262(6):955-64. doi: 10.1097/SLA.0000000000001078.
OBJECTIVE
To determine the association between race/ethnicity and perioperative outcomes in individuals undergoing major oncologic and nononcologic surgical procedures in the United States.
BACKGROUND
Prior work has shown that there are significant racial/ethnic disparities in perioperative outcomes after several types of major cardiac, general, vascular, orthopedic, and cancer surgical procedures. However, recent evidence suggests attenuation of these racial/ethnic differences, particularly at academic institutions.
METHODS
We utilized the American College of Surgeons National Surgical Quality Improvement Program database to identify 142,344 patients undergoing one of the 16 major cancer and noncancer surgical procedures between 2005 and 2011.
RESULTS
Eighty-five percent of the cohort was white, with black and Hispanic individuals comprising 8% and 4%, respectively. In multivariable analyses, black patients had greater odds of experiencing prolonged length of stay after 10 of the 16 procedures studied (all P < 0.05), though there was no disparity in odds of 30-day mortality after any surgery. Hispanics were more likely to experience prolonged length of stay after 5 surgical procedures (all P < 0.04), and were at greater odds of dying within 30 days after colectomy, heart valve repair/replacement, or abdominal aortic aneurysm repair (all P < 0.03). Fewer disparities were observed for Hispanics, than for black patients, and also for cancer, than for noncancer surgical procedures.
CONCLUSIONS
Important racial/ethnic disparities in perioperative outcomes were observed among patients undergoing major cancer and noncancer surgical procedures at American College of Surgeons National Surgical Quality Improvement Program institutions. There were fewer disparities among individuals undergoing cancer surgery, though black patients, in particular, were more likely to experience prolonged length of stay.
目的
确定在美国接受重大肿瘤和非肿瘤外科手术的个体中，种族/族裔与围手术期结局之间的关联。
背景
先前的研究表明，在几种类型的重大心脏、普通外科、血管、骨科和癌症手术之后，围手术期结局存在显著的种族/族裔差异。然而，最近的证据表明这些种族/族裔差异有所减弱，尤其是在学术机构中。
方法
我们利用美国外科医师学会国家外科质量改进计划数据库，识别出2005年至2011年间接受16种重大癌症和非癌症手术之一的142344例患者。
结果
该队列中85%为白人，黑人和西班牙裔个体分别占8%和4%。在多变量分析中，黑人患者在16种研究手术中的10种术后住院时间延长的几率更高（所有P<0.05），不过任何手术后30天死亡率的几率没有差异。西班牙裔在5种手术后更有可能出现住院时间延长（所有P<0.04），并且在结肠切除术、心脏瓣膜修复/置换或腹主动脉瘤修复后30天内死亡的几率更高（所有P<0.03）。与黑人患者相比，西班牙裔观察到的差异较少；与非癌症手术相比，癌症手术观察到的差异也较少。
结论
在美国外科医师学会国家外科质量改进计划机构中，接受重大癌症和非癌症手术的患者在围手术期结局方面存在重要的种族/族裔差异。癌症手术患者之间的差异较少，不过尤其是黑人患者更有可能出现住院时间延长。
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