社会经济地位并不会影响加拿大城市教学医院中腹股沟疝患者的就诊情况。
Socioeconomic status does not influence the presentation of patients with inguinal hernia at an urban Canadian teaching hospital.
机构信息
From the Trauma Research Unit, Dept. of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Laane); Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Laane); Vancouver General Hospital, Trauma Services, Vancouver, BC (Hameed, Joos); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed, Joos); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Chen); and the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman, Rosenkrantz)
From the Trauma Research Unit, Dept. of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Laane); Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Laane); Vancouver General Hospital, Trauma Services, Vancouver, BC (Hameed, Joos); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed, Joos); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Chen); and the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman, Rosenkrantz).
出版信息
Can J Surg. 2022 Apr 27;65(2):E282-E289. doi: 10.1503/cjs.007920. Print 2022 Mar-Apr.
BACKGROUND
Socioeconomic status (SES) has been shown to influence the outcomes of surgical pathologies in areas with unequal access to health care. The purpose of this study was to measure the effect of SES on the urgency for inguinal hernia repair in an area with purported equitable access to health care in the context of a universal health care system.
METHODS
We included all adult patients who underwent surgical management of an inguinal hernia between 2012 and 2016 at 2 urban academic centres. We measured the SES using the Vancouver Area Neighbourhood Deprivation Index (VANDIX) score.
RESULTS
We included 2336 patients: 98 emergency surgery and 294 elective surgery cases. We matched patients without replacement on age, sex and American Society of Anesthesiology score, using optimized propensity score matching at a ratio of 1 case to 3 controls. We found no significant correlation between lower SES and emergency surgical management ( = 0.122). Secondary analysis assessed the impact of SES on morbidity and length of stay. We found no significant difference in the rate of complications, length of stay and recurrence by SES category. Patients from lower SES brackets had increased odds for readmission (odds ratio 1.979; 95% confidence interval 1.111-4.318).
CONCLUSION
We found no correlation between a low SES and the need for emergency inguinal hernia repair, but found an increased rate of readmission in patients from lower SES brackets. This finding should be further scrutinized through a deeper dive into the barriers to access to nonacute care settings, such as home care.
背景
社会经济地位（SES）已被证明会影响到医疗保健机会不平等地区的手术病理结果。本研究的目的是在全民医疗保健体系的背景下，衡量 SES 对腹股沟疝修补术紧迫性的影响，该地区据称可公平获得医疗保健。
方法
我们纳入了 2012 年至 2016 年期间在 2 个城市学术中心接受手术治疗的所有成年腹股沟疝患者。我们使用温哥华地区邻里剥夺指数（VANDIX）评分来衡量 SES。
结果
我们纳入了 2336 名患者：98 例急诊手术和 294 例择期手术。我们通过优化的倾向评分匹配，在没有替代方案的情况下，按年龄、性别和美国麻醉医师协会评分进行了匹配，匹配比例为 1 例对 3 例对照。我们发现 SES 与紧急手术管理之间没有显著相关性（ = 0.122）。二次分析评估了 SES 对发病率和住院时间的影响。我们发现 SES 类别与并发症发生率、住院时间和复发率之间无显著差异。SES 较低的患者再次入院的可能性增加（优势比 1.979；95%置信区间 1.111-4.318）。
结论
我们发现 SES 较低与紧急腹股沟疝修补术的需求之间没有相关性，但 SES 较低的患者再次入院的比例较高。这一发现应通过深入研究获得非急性护理环境（如家庭护理）的获取障碍来进一步审查。
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