Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
J Surg Res. 2021 Jun;262:165-174. doi: 10.1016/j.jss.2021.01.004. Epub 2021 Feb 12.
Racial disparity in surgical access and postoperative outcomes after pulmonary lobectomy continues to be a concern and target for improvement; however, evidence of independent impact of race on complications is lacking. The objective of this study was to investigate the impact of race/ethnicity on surgical outcomes after lobectomy for lung cancer and estimate the distribution of racial/ethnic groups among expected resectable lung cancer cases using a large national database.
Patients who underwent lobectomy for lung cancer between 2005 and 2016 were identified in the American College of Surgeon National Surgical Quality Improvement Program. Preoperative characteristics and postoperative outcomes were compared between race/ethnicity groups in all patients and in propensity-matched cohorts, controlling for pertinent risk factors. Distribution of each race/ethnicity in the database was calculated relative to estimated numbers of patients with resectable lung cancer in the United States.
A total of 10,202 patients (age 67.6 ± 9.7, 46.7% male, 86.4% white) underwent nonemergent lobectomy (46.8% thoracoscopic). Blacks had higher rates of baseline risk factors. In propensity score-matched cohorts of whites, blacks, and Hispanics/Asians (n = 498 each), postoperatively, blacks had higher rates of prolonged intubation and longer hospital stay while whites had a higher rate of pneumonia. Race was independently associated with these adverse outcomes on multivariate analysis. Proportion of blacks and Hispanics in the American College of Surgeon National Surgical Quality Improvement Program was lower than their respective proportion of resectable lung cancer in the United States.
In a large national-level surgical database, there was lower than expected representation of black and Hispanic patients. Black race was independently associated with extended length of stay and prolonged intubation, whereas white was independently associated with postoperative pneumonia.
肺叶切除术后手术机会和术后结果的种族差异仍然是人们关注和改进的目标；然而，种族对并发症的独立影响的证据仍然缺乏。本研究的目的是调查种族/民族对肺癌肺叶切除术后手术结果的影响，并使用大型国家数据库估计可切除肺癌病例中种族/民族群体的分布。
在美国外科医师学院国家外科质量改进计划中，确定了 2005 年至 2016 年间接受肺叶切除术治疗肺癌的患者。在所有患者和倾向匹配队列中，比较了种族/民族群体之间的术前特征和术后结果，控制了相关的危险因素。根据美国可切除肺癌患者的估计数量，计算了数据库中每个种族/民族的分布情况。
共有 10202 例患者（年龄 67.6±9.7 岁，46.7%为男性，86.4%为白人）接受了非紧急肺叶切除术（46.8%为胸腔镜手术）。黑人的基线危险因素发生率较高。在白人、黑人、西班牙裔/亚裔的倾向评分匹配队列中（每组 498 例），术后黑人的气管插管时间延长和住院时间延长的发生率较高，而白人的肺炎发生率较高。多变量分析显示，种族与这些不良结局独立相关。美国外科医师学院国家外科质量改进计划中黑人及西班牙裔的比例低于他们各自在美国可切除肺癌中的比例。
在一个大型的全国性外科手术数据库中，黑人及西班牙裔患者的比例低于预期。黑人种族与住院时间延长和气管插管时间延长独立相关，而白人种族与术后肺炎独立相关。
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