Bonner Sidra N, He Chang, Clark Melissa, Adams Kumari, Orelaru Felix, Popoff Andrew, Chang Andrew, Wakeam Elliot, Lagisetty Kiran
Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Ann Surg Oncol. 2023 Jan;30(1):517-526. doi: 10.1245/s10434-022-12435-x. Epub 2022 Aug 26.
Persistent racial disparities in lung cancer incidence, treatment, and survival are well documented. Given the importance of surgical resection for lung cancer treatment, racial disparities in surgical quality were investigated using a statewide quality collaborative.
This retrospective study used data from the Michigan Society of Cardiothoracic Surgeons General Thoracic database, which includes data gathered for the Society of Thoracic Surgeons General Thoracic Surgery Database at 17 institutions in Michigan. Adult patients undergoing resection for lung cancer between 2015 and 2021 were included. Propensity score-weighting methodology was used to assess differences in surgical quality, including extent of resection, adequate lymph node evaluation, 30-day mortality, and 30-day readmission rate between white and black patients.
The cohort included 5073 patients comprising 357 (7%) black and 4716 (93%) white patients. The black patients had significantly higher unadjusted rates of wedge resection than the white patients, but after propensity score-weighting for clinical factors, wedge resection did not differ from lobectomy (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.78-1.49; P = 0.67). The black patients had fewer lymph nodes collected (incidence rate ratio [IRR], 0.77; 95% CI, 0.73-0.81; P < 0.0001) and lymph node stations sampled (IRR, 0.89; 95% CI, 0.84-0.94; P < 0.0001). The black patients did not differ from the white patients in terms of mortality (OR, 0.65; 95% CI, 0.19-2.34; P = 0.55) or readmission (OR, 0.79; 95 % CI, 0.49-1.27; P = 0.32). The black patients had longer hospital stays (OR, 1.08; 95% CI, 1.02-1.14; P = 0.01).
In a statewide quality collaborative that included high-volume centers, black patients received a less extensive lymph node evaluation, with fewer non-anatomic wedge resections performed, and a more limited lymph node evaluation with lobectomy.
肺癌发病率、治疗和生存率方面持续存在的种族差异已有充分记录。鉴于手术切除对肺癌治疗的重要性，我们利用全州质量协作组织对手术质量方面的种族差异进行了调查。
这项回顾性研究使用了密歇根心胸外科医师协会普通胸科数据库中的数据，该数据库包含密歇根州17家机构为胸外科医师协会普通胸外科手术数据库收集的数据。纳入2015年至2021年间接受肺癌切除术的成年患者。采用倾向得分加权方法评估白人和黑人患者在手术质量方面的差异，包括切除范围、充分的淋巴结评估、30天死亡率和30天再入院率。
该队列包括5073例患者，其中357例（7%）为黑人，4716例（93%）为白人。黑人患者楔形切除术的未调整率显著高于白人患者，但在对临床因素进行倾向得分加权后，楔形切除术与肺叶切除术无差异（优势比[OR]，1.07；95%置信区间[CI]，0.78 - 1.49；P = 0.67）。黑人患者收集的淋巴结较少（发病率比[IRR]，0.77；95% CI，0.73 - 0.81；P < 0.0001），且采样的淋巴结站较少（IRR，0.89；95% CI，0.84 - 0.94；P < 0.0001）。黑人患者在死亡率（OR，0.65；95% CI，0.19 - 2.34；P = 0.55）或再入院率（OR，0.79；95% CI，0.49 - 1.27；P = 0.32）方面与白人患者无差异。黑人患者的住院时间更长（OR，1.08；95% CI，1.02 - 1.14；P = 0.01）。
在一个包括大容量中心的全州质量协作组织中，黑人患者接受的淋巴结评估范围较小，非解剖性楔形切除术较少，肺叶切除术的淋巴结评估也更有限。
