Lassiter Randi L, Talukder Asif, Abrams Meryl M, Adam Bao-Ling, Albo Daniel, White Cassandra Q
Department of Surgery, Augusta University, 1120 15th St, Augusta, GA 30912, USA.
Am J Surg. 2017 Apr;213(4):673-677. doi: 10.1016/j.amjsurg.2016.11.019. Epub 2016 Nov 17.
Several studies have demonstrated favorable outcomes for laparoscopic surgery over open surgery for the treatment of diverticular disease. This study was designed to analyze the relationship between race, socioeconomic status and the use of laparoscopy to address diverticulitis.
A retrospective analysis of 53,054 diverticulitis admissions was performed using data from the 2009-2013 National Inpatient Sample (NIS). The primary outcome was the use of laparoscopic versus open colectomy. Bivariate analysis and multivariable logistic regression were used to determine the raw and adjusted odds by race, insurance status, and median household income.
Overall, 41.6% of colectomies involved the use of laparoscopy. Black patients were 19% less likely than White patients to undergo laparoscopic surgery. Hispanic patients were no more or less likely to undergo laparoscopic colectomy. Lacking private insurance was a strong predictor of undergoing open surgery. Lower income patients were 33% less likely to receive minimally invasive colectomies.
These results demonstrate disparities in surgical treatment. Further research is warranted to understand and ameliorate treatment differences which can contribute to outcome disparities.
多项研究表明,在治疗憩室病方面,腹腔镜手术的效果优于开放手术。本研究旨在分析种族、社会经济地位与使用腹腔镜治疗憩室炎之间的关系。
利用2009 - 2013年全国住院患者样本(NIS)的数据,对53054例憩室炎住院病例进行回顾性分析。主要结局是腹腔镜与开放结肠切除术的使用情况。采用双变量分析和多变量逻辑回归来确定按种族、保险状况和家庭收入中位数的原始及调整后的比值比。
总体而言,41.6%的结肠切除术采用了腹腔镜手术。黑人患者接受腹腔镜手术的可能性比白人患者低19%。西班牙裔患者接受腹腔镜结肠切除术的可能性无差异。缺乏私人保险是接受开放手术的一个有力预测因素。低收入患者接受微创结肠切除术的可能性低33%。
这些结果表明手术治疗存在差异。有必要进行进一步研究,以了解并改善可能导致结局差异的治疗差异。