Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
Surg Endosc. 2023 Jul;37(7):5561-5569. doi: 10.1007/s00464-022-09732-7. Epub 2022 Oct 28.
Non-white patients have been shown to have higher rates of emergent VHR, though no study to date has characterized these disparities over time.
National Surgical Quality Improvement Program (NSQIP) database was queried for VHR patients between 2008 and 2019. White, black, and hispanic patients were included for analysis. Older (2008-2011) versus New (2016-2019) time-periods were compared. The primary outcome was emergent VHR proportion. Multivariable analysis identified predictors of emergent VHR, then patients in each time-period were propensity matched (PSM) to control for confounders.
The 665,809 VHRs between 2008 and 2019 consisted of 69.2% white, 9.7% black, and 8.1% hispanic patients. Emergent VHR rates were higher (all p < 0.001) for black (6.8%) and hispanic (5.6%) patients compared to White (4.1%). Emergent VHR rates between white vs black and white vs hispanic for both old (4.6% vs 7.4% and 4.6% vs 7.4%) and new (3.6% vs 5.8% and 3.6% vs 5.1%) groups demonstrated lower rates in White patients (all p < 0.001). Ratios of emergent VHR rates over time (old to new) remained similar (black:white 1.61-1.61; hispanic:white 1.43-1.42). Multivariable analysis showed older age, higher BMI, smoking, female sex, and increasing ASA class increased odds for emergent VHR. Comparison of PSM-groups (white-PSM vs black-PSM and white-PSM vs hispanic-PSM) for both old (5.0% vs 7.0% and 3.6% vs 6.3%) and new (3.2% vs 4.8% and 3.8% vs 5.5%) time-periods showed lower emergent VHR rates in white patients (all p < 0.001). Ratios of emergent VHR rates over time increased for black patients and decreased for Hispanic patients (black:white:1.4 to 1.5, and hispanic:white:1.75 to 1.45).
Black and Hispanic patients have higher rates of emergent VHR compared to White patients, and this has not improved over time. After PSM to control for confounding variables, disparities in emergent VHR rates have increased for Black patients and decreased for Hispanic patients.
已证实非白人患者急诊 VHR 的发生率较高，但迄今为止尚无研究随时间推移描述这些差异。
2008 年至 2019 年期间，国家外科质量改进计划（NSQIP）数据库对 VHR 患者进行了查询。纳入白种人、黑人和西班牙裔患者进行分析。比较了较老（2008-2011 年）和较新（2016-2019 年）的时间段。主要结局是急诊 VHR 比例。多变量分析确定了急诊 VHR 的预测因素，然后对每个时间段的患者进行倾向评分匹配（PSM）以控制混杂因素。
2008 年至 2019 年间的 665809 例 VHR 中，白种人占 69.2%，黑种人占 9.7%，西班牙裔占 8.1%。黑人（6.8%）和西班牙裔（5.6%）患者的急诊 VHR 发生率较高（均 p<0.001）。白人患者的急诊 VHR 发生率较低（均 p<0.001），白种人比黑人和白种人比西班牙裔的老（4.6%比 7.4%和 4.6%比 7.4%）和新（3.6%比 5.8%和 3.6%比 5.1%）组的比率也较低。随着时间的推移（旧到新），急诊 VHR 发生率的比值保持相似（黑人：白人 1.61-1.61；西班牙裔：白人 1.43-1.42）。多变量分析显示，年龄较大、BMI 较高、吸烟、女性和 ASA 分级增加都会增加急诊 VHR 的几率。对老（5.0%比 7.0%和 3.6%比 6.3%）和新（3.2%比 4.8%和 3.8%比 5.5%）时间段的 PSM 组（白种人-PSM 比黑种人-PSM 和白种人-PSM 比西班牙裔-PSM）进行比较显示，白人患者的急诊 VHR 发生率较低（均 p<0.001）。随着时间的推移，黑人患者的急诊 VHR 发生率增加，而西班牙裔患者的急诊 VHR 发生率下降（黑人：白人 1.4 到 1.5，西班牙裔：白人 1.75 到 1.45）。
与白人患者相比，黑人和西班牙裔患者的急诊 VHR 发生率较高，而且这种情况并没有随着时间的推移而改善。在进行 PSM 以控制混杂变量后，黑人患者的急诊 VHR 率差异增加，而西班牙裔患者的急诊 VHR 率差异减少。
