Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2022 Feb;158:244-257.e1. doi: 10.1016/j.wneu.2021.11.106. Epub 2021 Nov 29.
This systematic review analyzes contemporary literature on racial/ethnic, insurance, and socioeconomic disparities within cerebrovascular surgery in the United States to determine areas for improvement.
We conducted an electronic database search of literature published between January 1990 and July 2020 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies analyzing a racial/ethnic, insurance, or socioeconomic disparity within adult cerebrovascular surgery.
Of 2873 articles screened for eligibility by title and abstract, 970 underwent full-text independent review by 3 authors. Twenty-seven additional articles were identified through references to generate a final list of 47 included studies for analysis. Forty-six were retrospective reviews and 1 was a prospective observational cohort study, thereby comprising Levels III and IV of evidence. Studies investigated carotid artery stenting (11/47, 23%), carotid endarterectomy (22/47, 46.8%), mechanical thrombectomy (8/47, 17%), and endovascular aneurysm coiling or surgical aneurysm clipping (20/47, 42.6%). Minority and underinsured patients were less likely to receive surgical treatment. Non-White patients were more likely to experience a postoperative complication, although this significance was lost in some studies using multivariate analyses to account for complication risk factors. White and privately insured patients generally experienced shorter length of hospital stay, had lower rates of in-hospital mortality, and underwent routine discharge. Twenty-five papers (53%) reported no disparities within at least one examined metric.
This comprehensive contemporary systematic review demonstrates the existence of disparity gaps within the field of adult cerebrovascular surgery. It highlights the importance of continued investigation into sources of disparity and efforts to promote equity within the field.
本系统评价分析了美国脑血管外科学中种族/民族、保险和社会经济差异的当代文献，以确定需要改进的领域。
我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 1990 年 1 月至 2020 年 7 月期间发表的文献进行了电子数据库搜索，以分析成人脑血管外科学中种族/民族、保险或社会经济差异的研究。
在标题和摘要筛选出的 2873 篇文章中，有 970 篇由 3 位作者进行了全文独立审查。通过参考文献又确定了 27 篇额外的文章，最终有 47 篇纳入研究进行分析。其中 46 篇为回顾性研究，1 篇为前瞻性观察队列研究，因此包含了 III 级和 IV 级证据。研究调查了颈动脉支架置入术（11/47，23%）、颈动脉内膜切除术（22/47，46.8%）、机械血栓切除术（8/47，17%）和血管内动脉瘤弹簧圈栓塞或手术夹闭动脉瘤（20/47，42.6%）。少数民族和保险不足的患者接受手术治疗的可能性较低。非白人患者术后发生并发症的可能性更高，但在一些使用多变量分析来考虑并发症风险因素的研究中，这种显著性消失了。白人患者和私人保险患者通常住院时间较短，住院死亡率较低，且常规出院。25 篇论文（53%）至少在一个检查指标上报告没有差异。
本全面的当代系统评价展示了成人脑血管外科学领域中存在差异差距。它强调了继续调查差异来源以及努力促进该领域公平性的重要性。
