Damle Rachelle N, Flahive Julie M, Davids Jennifer S, Maykel Justin A, Sturrock Paul R, Alavi Karim
1 Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 2 Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 3 Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts.
Dis Colon Rectum. 2016 Nov;59(11):1055-1062. doi: 10.1097/DCR.0000000000000692.
Racial disparities in outcomes are well described among surgical patients.
The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery.
Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach.
The study was conducted at academic hospitals and their affiliates.
Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included.
The receipt of a minimally invasive surgical approach was the main measured outcome.
A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79-0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21-1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery.
The study was limited by the retrospective nature of its data.
We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.
手术患者的结局存在种族差异，这已得到充分描述。
本研究旨在确定结直肠手术采用微创方法方面是否存在种族差异。
利用大学卫生系统联合会对接受结直肠手术的成年人进行研究。采用单变量和多变量分析来确定接受微创方法的预测因素。
研究在学术医院及其附属医院开展。
纳入2008年至2011年间接受结直肠癌、憩室病、炎症性肠病或结直肠良性肿瘤手术的18岁及以上成年人。
主要观察指标是是否接受微创外科手术方法。
共有82474名成年患者符合研究纳入标准。其中，69664名（84%）为白人，10874名（13%）为黑人，1936名（2%）为亚洲人。与白人和亚洲患者相比，黑人患者更年轻，公共保险覆盖率更高，合并症负担更重，疾病基线严重程度更高。与白人相比，黑人患者接受微创手术的可能性较小（调整后的比值比=0.83（95%置信区间，0.79 - 0.87）），而亚洲患者接受微创手术的可能性更大（调整后的比值比=1.34（95%置信区间，1.21 - 1.49））。这种关联在按保险类型（公共或私人）分层时没有变化。与白人和亚洲患者相比，黑人患者入住重症监护病房和非家庭出院的比例更高，住院时间也更长。微创手术在并发症、再入院或死亡率方面没有差异，但黑人患者接受开放手术时更有可能再次入院或死亡。
本研究受其数据回顾性本质的限制。
我们发现，无论保险状况如何，结直肠手术采用微创方法存在种族差异，而且与开放手术相比，接受微创技术的少数族裔患者结局有所改善。与微创手术相关的改善结局应促使人们努力提高黑人患者对其的使用率。
