社会经济地位对机器人辅助肺叶切除术后围手术期结局的影响
Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy.
作者信息
Jermihov Anastasia, Chen Liwei, Echavarria Maria F, Ng Emily P, Velez Frank O, Moodie Carla C, Garrett Joseph R, Fontaine Jacques P, Toloza Eric M
机构信息
School of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA.
Surgery, University of South Florida Health Morsani College of Medicine, Tampa, USA.
出版信息
Cureus. 2022 Jun 22;14(6):e26201. doi: 10.7759/cureus.26201. eCollection 2022 Jun.
BACKGROUND
Lower socioeconomic status (SES) has been correlated with poor survival rates and surgical outcomes following lung cancer resection. This study sought to determine whether this disparity exists perioperatively in lung cancer patients following robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods: We retrospectively reviewed 447 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Ten patients were excluded due to incomplete data. We used median income by residential ZIP code as a surrogate for SES status and grouped patients based on whether ZIP-based median income was less than (Group 1) or greater than (Group 2) 300% of the federal poverty income level. The effects of SES status groups on incidence of postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were evaluated by the logistic regression model and Inverse Gaussian regression model, respectively.
RESULTS
Without adjustment, Group 1 tended to have a higher rate of postoperative complications, with 54% of patients experiencing complications compared to 34% of patients in Group 2 (p=0.007). Median chest tube duration and hospital LOS were also significantly longer in Group 1 than in Group 2 (p=0.034). In multivariable logistical regression analysis, while controlling for covariates and considering effect modifications, lower SES was significantly and positively associated with postoperative complications (odds ratio (OR)=1.98, p=0.039). Preoperative chronic obstructive pulmonary disease (COPD) was also a positive and significant predictor of postoperative complications (OR=1.89, p=0.017), chest tube duration (p=0.020), and LOS (p=0.010).
CONCLUSIONS
Lower median income is associated with a greater number of postoperative complications following pulmonary resection for lung cancer when controlling for covariates.
背景
社会经济地位较低（SES）与肺癌切除术后生存率低及手术结果不佳相关。本研究旨在确定在机器人辅助电视胸腔镜肺叶切除术后的肺癌患者围手术期是否存在这种差异。方法：我们回顾性分析了由一名外科医生为已知或疑似肺癌患者实施机器人辅助肺叶切除术的447例连续患者。因数据不完整排除10例患者。我们使用居住邮政编码区域的收入中位数作为SES状况的替代指标，并根据基于邮政编码的收入中位数是低于（第1组）还是高于（第2组）联邦贫困收入水平的300%对患者进行分组。分别通过逻辑回归模型和逆高斯回归模型评估SES状况组对术后并发症发生率、胸管留置时间、住院时间（LOS）和院内死亡率的影响。
结果
未经调整时，第1组术后并发症发生率往往较高，54%的患者发生并发症，而第2组为34%（p = 0.007）。第1组的胸管留置时间中位数和住院LOS也显著长于第2组（p = 0.034）。在多变量逻辑回归分析中，在控制协变量并考虑效应修正的情况下，较低的SES与术后并发症显著正相关（比值比（OR）= 1.98，p = 0.039）。术前慢性阻塞性肺疾病（COPD）也是术后并发症（OR = 1.89，p = 0.017）、胸管留置时间（p = 0.020）和LOS（p = 0.010）的正向显著预测因素。
结论
在控制协变量的情况下，较低的收入中位数与肺癌肺切除术后更多的术后并发症相关。
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