Shenoy Rivfka, Kirkland Patrick, Maggard-Gibbons Melinda, Russell Marcia M
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA; National Clinician Scholars Program, UCLA, Los Angeles, CA.
Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA.
J Surg Res. 2022 Apr;272:88-95. doi: 10.1016/j.jss.2021.11.003. Epub 2021 Dec 22.
Cholecystectomy is one of the most common surgeries and the majority are performed to treat symptomatic cholelithiasis (SC). While surgery is often elective, poor access or delays in care may lead to urgent cases, which are potentially associated with higher complication rates. This study aims to determine if minority patients with SC have higher rates of urgent cholecystectomy and postoperative complications.
Analysis of patients undergoing cholecystectomy for SC utilizing American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2017 to 2019. Primary outcome was acuity of cholecystectomy (i.e., urgent versus elective). Secondary outcomes were any post-operative complication and length of stay.
Patients who underwent cholecystectomy for SC between 2017 to 2019 (N: 13,390) were analyzed. Hispanic and non-Hispanic Black patients had higher odds of undergoing urgent surgery as compared to non-Hispanic White patients, and Hispanics had over twice the odds (adjusted odds ratio (aOR), 2.16; 95% CI 1.93-2.43), adjusting for age, sex, and comorbidities. Having urgent surgery was associated with higher odds for developing any postoperative complication and experiencing longer length of stay. After adjusting for urgency of surgery, Non-Hispanic Black and Asian patients were at risk for higher postoperative length of stay.
Hispanic and non-Hispanic Black patients were more likely to undergo urgent cholecystectomy as compared to non-Hispanic White patients for SC. Urgent surgery was independently associated with a higher complication rate and longer length of stay. Further characterization of the delays to surgery that lead to these differences are critical to prevent further treatment disparities.
胆囊切除术是最常见的手术之一，大多数手术是为了治疗有症状的胆结石（SC）。虽然手术通常是选择性的，但就医不便或护理延迟可能导致急症病例，这可能与更高的并发症发生率相关。本研究旨在确定患有SC的少数族裔患者进行急诊胆囊切除术和术后并发症的发生率是否更高。
利用美国外科医师学会国家外科质量改进计划（ACS NSQIP）对2017年至2019年因SC接受胆囊切除术的患者进行分析。主要结局是胆囊切除术的急症程度（即急诊与择期）。次要结局是任何术后并发症和住院时间。
分析了2017年至2019年间因SC接受胆囊切除术的患者（N：13390）。与非西班牙裔白人患者相比，西班牙裔和非西班牙裔黑人患者接受急诊手术的几率更高，西班牙裔的几率是其两倍多（调整后的优势比（aOR），2.16；95%可信区间1.93 - 2.43），并对年龄、性别和合并症进行了调整。进行急诊手术与发生任何术后并发症和住院时间延长的几率更高相关。在对手术急症程度进行调整后，非西班牙裔黑人和亚洲患者术后住院时间有延长的风险。
与非西班牙裔白人患者相比，西班牙裔和非西班牙裔黑人患者因SC更有可能接受急诊胆囊切除术。急诊手术与更高的并发症发生率和更长的住院时间独立相关。进一步明确导致这些差异的手术延迟特征对于防止进一步的治疗差异至关重要。
