School of Medicine, University of Utah, Salt Lake City, Utah, USA.
School of Medicine, University of Nevada, Reno, Nevada, USA.
Neurosurgery. 2023 Jul 1;93(1):176-185. doi: 10.1227/neu.0000000000002397. Epub 2023 Feb 10.
Race-based health care outcomes remain to be described in anterior cranial fossa (ACF) surgery.
To determine whether race predicts worse outcomes after ACF surgery.
A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program data for 2005 to 2020. Current Procedural Terminology and International Classification of Diseases-9 codes were used to identify ACF tumor cases. Propensity score matching was performed to compare White and minority patients to assess the robustness of unmatched findings. A subanalysis of pituitary adenoma (PA) resections was also performed.
In an unmatched analysis of 1370 patients who underwent ACF surgery (67.9% White, 17.4% Black, 6.6% Asian/Pacific Islander, and 6.3% Hispanic), minority groups had higher rates of comorbidities. Unmatched multivariate analysis found Hispanic patients bore a 1.86 odds ratio (OR) of minor complications, Black and Asian and Pacific Islander patients bore 1.49 and 1.71 ORs, respectively, for extended length of stay, and Black patients bore a 3.78 OR for urinary tract infection (UTI). Matched analysis found that minority patients had higher UTI rates ( P = .02) and a 4.11 OR of UTI. In PA cases specifically, minority groups had higher comorbidities and length of stay in addition to extended length of stay odds (1.84 OR).
Although most ACF surgery outcomes were unaffected by race, minority groups had more minor postoperative complications than White patients, particularly UTI. Similar disparities were observed among PA cases. Higher rates of comorbidities may also have led to longer hospital stays. Further study is needed to understand what actions might be necessary to address any race-associated health disparities in ACF surgery.
种族与健康结果之间的关联在颅前窝（ACF）手术中仍有待描述。
确定种族是否预示着 ACF 手术后的结果更差。
本研究使用美国外科医师学会国家手术质量改进计划 2005 年至 2020 年的数据进行回顾性队列研究。使用当前手术术语和国际疾病分类第 9 版代码来识别 ACF 肿瘤病例。进行倾向评分匹配以比较白人和少数族裔患者，以评估未匹配发现的稳健性。还对垂体腺瘤（PA）切除术进行了亚分析。
在未匹配的 1370 例接受 ACF 手术的患者分析中（67.9%为白人，17.4%为黑人，6.6%为亚洲/太平洋岛民，6.3%为西班牙裔），少数族裔患者的合并症发生率更高。未匹配的多变量分析发现，西班牙裔患者发生轻微并发症的几率为 1.86 倍（OR），黑人和亚洲/太平洋岛民患者的住院时间延长的几率分别为 1.49 和 1.71 OR，黑患者发生尿路感染（UTI）的几率为 3.78 倍（OR）。匹配分析发现，少数族裔患者的 UTI 发生率更高（P =.02），UTI 的 OR 为 4.11。具体到 PA 病例，少数族裔患者除了住院时间延长的几率更高外，还存在更高的合并症和住院时间（1.84 倍 OR）。
尽管大多数 ACF 手术结果不受种族影响，但少数族裔患者的术后轻微并发症发生率高于白人患者，尤其是 UTI。PA 病例中也观察到类似的差异。更高的合并症发生率也可能导致住院时间延长。需要进一步研究以了解需要采取哪些措施来解决 ACF 手术中与种族相关的健康差异。
