Choi Christine S, Koltun Walter A, Hollenbeak Christopher S
1 Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania 2 Department Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Dis Colon Rectum. 2016 Mar;59(3):216-23. doi: 10.1097/DCR.0000000000000526.
Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology.
The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy.
Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients.
Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy.
The primary outcomes were in-hospital mortality, hospital length of stay, and total costs.
Asian patients were younger (56.1 vs. 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs. 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs. 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs. Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs. Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs. Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant.
The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database.
Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.
尽管人们认为右侧憩室炎在亚洲人中的发病率较高，且与乙状结肠憩室炎相比，其很少需要手术治疗，但目前尚不清楚治疗结果的差异是由于种族差异还是疾病病理生理所致。
本研究旨在确定接受结肠切除术的亚洲和非亚洲憩室炎患者的手术结果。
纳入2004年至2010年间全国住院患者样本中可按种族识别的憩室炎及接受结肠切除术的患者。对亚洲和非亚洲患者进行单因素比较，连续变量采用t检验，分类变量采用χ检验。进行倾向评分匹配分析，以比较亚洲患者与其他情况相似的非亚洲患者。
纳入58142例接受结肠切除术的非亚洲憩室炎患者和335例亚洲憩室炎患者。
主要结局指标为住院死亡率、住院时间和总费用。
亚洲患者更年轻（56.1岁 vs. 59.2岁，p < 0.0001），更有可能接受右半结肠切除术（22.7% vs. 4.1%，p < 0.0001），且比非亚洲患者更有可能接受急诊/紧急手术（67.1% vs. 49.8%，p < 0.0001）。在未控制患者/疾病因素的情况下，死亡率（非亚洲患者2.2% vs. 亚洲患者4.2%；p = 0.014）、住院时间（非亚洲患者8.9天 vs. 亚洲患者9.8天；p = 0.0166）和费用（非亚洲患者18783美元 vs. 亚洲患者21901美元；p = 0.001）存在统计学显著差异。对333例非亚洲患者与333例情况相似的亚洲患者进行倾向评分匹配分析显示，虽然费用和住院时间的差异不再显著，但死亡率差异仍具有统计学显著性。
全国住院患者样本数据库中并非所有州都统一收集了种族变量。
在接受结肠切除术治疗憩室炎的患者中，亚洲患者和右侧疾病患者的死亡率较高。未来有必要进行纵向研究，比较右侧和左侧憩室炎的自然病史及治疗结果，以调查是否真的存在种族差异。
