Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Section of Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
J Card Surg. 2022 Aug;37(8):2247-2257. doi: 10.1111/jocs.16573. Epub 2022 May 8.
Prior studies have demonstrated deleterious outcomes for physician-patient racial discordance. We explored recipient-surgeon racial concordance and short-term postoperative survival in adults undergoing orthotopic heart transplantation (OHT).
The United Network for Organ Sharing (UNOS) database was queried to identify White and Black adult (≥18 years) patients undergoing isolated OHT between 2000 and 2020. Surgeon race was obtained from publicly available images. All non-White and non-Black recipients and surgeons were excluded. Linear probability models were utilized to explore the relationship between recipient-surgeon racial concordance and 30-, 60-, and 90-day post-transplant mortality using a fixed effects approach.
A total of 26,133 recipients were identified (mean age 52.79 years, 74.4% male) with 77.65% (n = 20,292) being White and 22.35% (n = 5841) being Black. A total of 662 White surgeons performed 25,946 (97.56%) OHTs during the study period while 17 Black surgeons performed 437 (1.67%) OHTs. Although some evidence of differences across groups was observed in cross-tabular specifications, these differences became insignificant after the inclusion of controls (i.e., comorbidities and fixed effects). This suggests that recipient race and physician race are not correlated with post-OHT survival at 30, 60, or 90 days.
Recipient-surgeon racial concordance and discordance among adults undergoing OHT do not appear to impact post-transplant survival. Nor do we observe significant penalties accruing for Black patients overall once controls are accounted for. Given that worse outcomes have historically been demonstrated for Black patients undergoing OHT, further work will be necessary to improve understanding of racial disparities for patients with end-stage heart failure.
先前的研究表明，医生与患者之间的种族差异会导致不良后果。我们探讨了接受者-外科医生种族一致性与成人原位心脏移植（OHT）术后短期生存的关系。
我们查询了 United Network for Organ Sharing（UNOS）数据库，以确定 2000 年至 2020 年间接受过单独 OHT 的白人及黑人成年（≥18 岁）患者。外科医生的种族是从公开的图像中获得的。所有非白人和非黑人的接受者和外科医生均被排除在外。利用线性概率模型，采用固定效应方法，探讨接受者-外科医生种族一致性与移植后 30、60 和 90 天死亡率之间的关系。
共确定了 26133 名接受者（平均年龄 52.79 岁，74.4%为男性），其中 77.65%（n=20292）为白人，22.35%（n=5841）为黑人。在研究期间，共有 662 名白人外科医生进行了 25946 次（97.56%）OHT，而 17 名黑人外科医生进行了 437 次（1.67%）OHT。尽管在交叉表规格中观察到了一些组间差异的证据，但在纳入对照（即合并症和固定效应）后，这些差异变得不显著。这表明，接受者的种族和医生的种族与 OHT 后 30、60 或 90 天的移植后生存无关。
成人 OHT 中接受者-外科医生的种族一致性和不一致性似乎不会影响移植后的生存。在考虑到对照因素后，我们也没有观察到黑人患者总体上会产生显著的不利影响。鉴于黑人患者接受 OHT 的预后历来较差，需要进一步努力以增进对终末期心力衰竭患者种族差异的理解。
