Gandjian Matthew, Sareh Sohail, Premji Alykhan, Ugarte Ramsey, Tran Zachary, Bowens Nina, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA.
Surg Open Sci. 2021 Sep 10;6:45-50. doi: 10.1016/j.sopen.2021.08.003. eCollection 2021 Oct.
Although significant racial disparities in the surgical management of lower extremity critical limb threatening ischemia have been previously reported, data on disparities in lower extremity acute limb ischemia are lacking.
The 2012-2018 National Inpatient Sample was queried for all adult hospitalizations for acute limb ischemia ( = 225,180). Hospital-specific observed-to-expected rates of major lower extremity amputation were tabulated. Multivariable logistic and linear models were developed to assess the impact of race on amputation and revascularization.
Nonwhite race was associated with significantly increased odds of overall (adjusted odds ratio: 1.16, 95% confidence interval 1.06-1.28) and primary (adjusted odds ratio: 1.34, 95% confidence interval 1.17-1.53) major amputation, decreased odds of revascularization (adjusted odds ratio 0.79, 95% confidence interval 0.73-0.85), but decreased in-hospital mortality (adjusted odds ratio: 0.86, 95% confidence interval 0.74-0.99). The nonwhite group incurred increased adjusted index hospitalization costs (β: +$4,810, 95% confidence interval 3,280-6,350), length of stay (β: + 1.09 days, 95% confidence interval 0.70-1.48), and nonhome discharge (adjusted odds ratio: 1.15, 95% confidence interval 1.06-1.26).
Significant racial disparities exist in the management of and outcomes of lower extremity acute limb ischemia despite correction for variations in hospital amputation practices and other relevant hospital and patient characteristics. Whether the etiology lies primarily in patient, institution, or healthcare provider-specific factors has not yet been determined. Further studies of race-based disparities in management and outcomes of acute limb ischemia are warranted to provide effective and equitable care to all.
尽管先前已有报道称在下肢严重肢体缺血的外科治疗中存在显著的种族差异，但关于下肢急性肢体缺血差异的数据却很缺乏。
查询2012 - 2018年全国住院患者样本中所有因急性肢体缺血住院的成年人（n = 225,180）。列出各医院主要下肢截肢的观察到的与预期的比率。建立多变量逻辑回归和线性模型以评估种族对截肢和血管重建的影响。
非白人种族与总体（调整后的优势比：1.16，95%置信区间1.06 - 1.28）和初次（调整后的优势比：1.34，95%置信区间1.17 - 1.53）主要截肢的几率显著增加相关，血管重建的几率降低（调整后的优势比0.79，95%置信区间0.73 - 0.85），但住院死亡率降低（调整后的优势比：0.86，95%置信区间0.74 - 0.99）。非白人组的调整后的指数住院费用增加（β：+$4,810，95%置信区间3,280 - 6,350），住院时间延长（β：+1.09天，95%置信区间0.70 - 1.48），以及非回家出院（调整后的优势比：1.15，95%置信区间1.06 - 1.26）。
尽管对医院截肢操作及其他相关医院和患者特征的差异进行了校正，但在下肢急性肢体缺血的治疗和结局方面仍存在显著的种族差异。病因主要是患者、机构还是医疗服务提供者特定因素尚未确定。有必要进一步研究急性肢体缺血治疗和结局中基于种族的差异，以便为所有人提供有效且公平的治疗。
