DeAngelis Erik J, Zebley James A, Ileka Ikechukwu S, Ganguli Sangrag, Panahi Armon, Amdur Richard L, Vaziri Khashayar, Lee Juliet, Jackson Hope T
Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA.
Surg Endosc. 2023 Feb;37(2):1421-1428. doi: 10.1007/s00464-022-09381-w. Epub 2022 Jun 22.
Laparoscopic colectomy has been associated with improved recovery and decreased complications when compared to an open approach. Consequently, the rates of laparoscopic colectomy have increased. Race has been identified as a factor that influences a patient's likelihood of undergoing laparoscopic colectomy. Therefore, the purpose of this study is to analyze the rates of laparoscopic colectomy stratified by race over time.
Patients were selected using procedure codes for colectomy within the National Inpatient Sample (NIS) database from 2009 to 2018. The primary independent variable was race (Black, BL; Hispanic, HI; White, WH), and the primary outcome was surgical approach (laparoscopic vs open). Covariates included age, sex, case complexity, insurance status, income, year of surgery, urbanicity, region, bedsize, and teaching status. We examined the univariable association of race with laparoscopic vs open colectomy with chi-square. We used multivariable logistic regression to examine the association of race with procedure type adjusting for covariates. All analyses were done using SAS (version 9.4, Cary, NC) with p < .05 considered significant.
267,865 patients (25,000 BL, 19,685 HI, and 223,180 WH) were identified. Laparoscopy was used in 47% of cases, and this varied significantly by race (BL 44%, HI 49%, WH 47%, p < .0001). After adjusting for covariates, Black patients had significantly lower adjusted odds of undergoing laparoscopic colectomy vs White patients (aOR 0.92, p < 0.0001). Utilization of laparoscopy was similar in Hispanic compared to White patients (aOR 1.00, p = 0.9667). Racial disparity in the adjusted odds of undergoing laparoscopic colectomy was persistent over time.
Race was independently associated with the rate of laparoscopic colectomy, with Black patients less likely to receive laparoscopic surgery than White patients. This disparity persisted over a decade. Attention should be paid to increasing the rates of laparoscopic colectomy in under-represented populations in order to optimize surgical care and address racial disparities.
与开放手术相比，腹腔镜结肠切除术与更好的恢复和更低的并发症发生率相关。因此，腹腔镜结肠切除术的比例有所增加。种族已被确定为影响患者接受腹腔镜结肠切除术可能性的一个因素。因此，本研究的目的是分析不同种族随时间推移的腹腔镜结肠切除术比例。
使用2009年至2018年国家住院患者样本（NIS）数据库中的结肠切除术程序代码选择患者。主要自变量是种族（黑人，BL；西班牙裔，HI；白人，WH），主要结局是手术方式（腹腔镜与开放）。协变量包括年龄、性别、病例复杂性、保险状况、收入、手术年份、城市化程度、地区、床位规模和教学状况。我们用卡方检验研究种族与腹腔镜与开放结肠切除术的单变量关联。我们使用多变量逻辑回归来研究种族与调整协变量后的手术类型之间的关联。所有分析均使用SAS（版本9.4，北卡罗来纳州卡里）进行，p < 0.05被认为具有统计学意义。
共识别出267,865例患者（25,000例黑人，19,685例西班牙裔，223,180例白人）。47%的病例采用了腹腔镜手术，且这一比例因种族而异（黑人44%，西班牙裔49%，白人47%，p < 0.0001）。在调整协变量后，黑人患者接受腹腔镜结肠切除术的调整后概率显著低于白人患者（调整后比值比0.92，p < 0.0001）。与白人患者相比，西班牙裔患者腹腔镜手术的使用率相似（调整后比值比1.00，p = 0.9667）。接受腹腔镜结肠切除术的调整后概率的种族差异随时间持续存在。
种族与腹腔镜结肠切除术的比例独立相关，黑人患者接受腹腔镜手术的可能性低于白人患者。这种差异持续了十年以上。应关注提高代表性不足人群的腹腔镜结肠切除术比例，以优化手术治疗并解决种族差异问题。
