Johnson Andrea H, Parkison Abigail, Petre Benjamin M, Turcotte Justin J, Redziniak Daniel E
Anne Arundel Medical Center Orthopedics, Annapolis, MD, USA.
J Orthop. 2022 Feb 28;30:103-107. doi: 10.1016/j.jor.2022.02.022. eCollection 2022 Mar-Apr.
Disparities in access, utilization and outcomes exist throughout the healthcare system for minority groups, including racial and ethnic minorities; these disparities have wide-reaching implications for individuals as well as the healthcare system as a whole. This study will examine the impact of race on short and medium term outcomes for patients undergoing rotator cuff repair (RCR) using matched cohorts.
Patients undergoing arthroscopic rotator cuff repair from 2016 to 2018 were extracted from two national databases: the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and TriNetX Research Network. Using the ACS-NSQIP database, univariate analysis was performed to identify differences in comorbidities between white and minority patients. Patients were propensity score matched based on significant differences between groups and 30-day postoperative outcomes were assessed. These comorbidities were then used to propensity score match white and minority patients in the TriNetX database and two-year postoperative outcomes were evaluated.
Following propensity score matching, 3716 patients remained in each group from the ACS-NSQIP database and 4185 patients remained in each group from the TriNetX database. The OR time for minority patients was longer than white patient in the ACS-NSQIP database (92.2 vs. 87.6 min, p < .001). There was no difference in medium-term outcomes for repeat RCR, infection or frozen shoulder between white and minority patients in the TriNetX database.
After propensity score matching the only significant short-term outcome between white and minority patients undergoing RCR was a difference in OR time; there were no differences in medium-term outcomes. This may indicate that the source of racial disparities is one of access to healthcare rather than an innate difference in the patients' outcomes. Further study is needed to elucidate this issue.
在整个医疗系统中，包括种族和少数族裔在内的少数群体在医疗服务的可及性、利用率和治疗结果方面存在差异；这些差异对个人以及整个医疗系统都具有广泛影响。本研究将使用匹配队列研究种族对接受肩袖修复术（RCR）患者短期和中期治疗结果的影响。
从两个全国性数据库中提取2016年至2018年接受关节镜肩袖修复术的患者：美国外科医师学会国家外科质量改进计划（ACS-NSQIP）和TriNetX研究网络。使用ACS-NSQIP数据库进行单因素分析，以确定白人和少数族裔患者合并症的差异。根据组间显著差异对患者进行倾向得分匹配，并评估术后30天的治疗结果。然后使用这些合并症对TriNetX数据库中的白人和少数族裔患者进行倾向得分匹配，并评估术后两年的治疗结果。
经过倾向得分匹配后，ACS-NSQIP数据库中每组各有3716名患者，TriNetX数据库中每组各有4185名患者。在ACS-NSQIP数据库中，少数族裔患者的手术时间比白人患者长（92.2分钟对87.6分钟，p <.001）。在TriNetX数据库中，白人和少数族裔患者在再次进行RCR、感染或肩周炎的中期治疗结果方面没有差异。
经过倾向得分匹配后，接受RCR的白人和少数族裔患者之间唯一显著的短期治疗结果差异是手术时间不同；中期治疗结果没有差异。这可能表明种族差异的根源在于医疗服务的可及性，而非患者治疗结果的固有差异。需要进一步研究以阐明这一问题。
