Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
Am J Surg. 2020 Sep;220(3):525-531. doi: 10.1016/j.amjsurg.2020.01.044. Epub 2020 Jan 26.
The impact of safety net (SN) hospitals relative to racial and healthcare disparities remains largely unknown.
Using the Nationwide Inpatient Sample, adults undergoing coronary artery bypass grafting, colectomy, or total hip arthroplasty were identified. Multivariable regression analysis was performed to determine association between SN burden and outcomes. Within each SN burden tier, the association between race/ethnic group and outcomes was defined.
Overall 865,648 patients were identified. After adjustment for potential confounders, patients operated at the highest SN burden hospitals had increased odds of complications (OR 1.14, 95%CI 1.10-1.18), death (OR 1.41, 95%CI 1.31-1.52), FTR (OR 1.36, 95%CI 1.25-1.47) and a never event (OR 1.57, 95%CI 1.47-1.68). Irrespective of hospital SN burden, racial minorities had greater odds of a complication, and prolonged LOS compared to whites (p < 0.05).
While overall degree of safety net burden was associated with worse overall outcomes, SN hospitals did not mitigate racial disparities experienced by minority patients.
安全网 (SN) 医院对种族和医疗保健差距的影响在很大程度上尚不清楚。
使用全国住院患者样本，确定接受冠状动脉旁路移植术、结肠切除术或全髋关节置换术的成年人。进行多变量回归分析以确定 SN 负担与结果之间的关联。在每个 SN 负担等级内，定义了种族/族裔群体与结果之间的关联。
共确定了 865,648 名患者。在调整了潜在混杂因素后，在 SN 负担最高的医院接受手术的患者发生并发症的几率增加（OR 1.14，95%CI 1.10-1.18）、死亡（OR 1.41，95%CI 1.31-1.52）、FTR（OR 1.36，95%CI 1.25-1.47）和从不发生事件（OR 1.57，95%CI 1.47-1.68）。无论医院 SN 负担如何，少数民族患者发生并发症和 LOS 延长的几率均高于白人（p<0.05）。
尽管整体安全网负担程度与整体结果较差相关，但 SN 医院并没有减轻少数民族患者所经历的种族差异。
