Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
J Surg Res. 2023 Mar;283:889-897. doi: 10.1016/j.jss.2022.10.084. Epub 2022 Dec 8.
There has been increasing national attention on reducing healthcare disparities. Prior studies cite worse surgical outcomes and less use of laparoscopy for Black patients with diverticulitis. Re-evaluation of these disparities is lacking despite national initiatives to improve health equity. This study aimed to evaluate the association of race with short-term outcomes and surgical approaches in patients with acute diverticulitis.
The National Surgical Quality Improvement Program database was queried for patients who underwent nonelective surgery for acute diverticulitis from 2015 to 2019. Severity of presentation, morbidity, mortality, surgical approach, and ostomy creation were compared by race.
Of the 13,996 patients included in the study, 82.4% were White, 7.6% were Black, 1.1% Asian, 0.61% American Indian/Alaska Native, and 0.20% Native Hawaiian/Pacific Islander (NH/PI). Overall 30-day morbidity was 44.3% and 30-day mortality was 3.9%. In a multivariate logistic regression analysis, compared to Whites, Black race was independently associated with higher 30-day morbidity (Odds Ratio: 1.24, 95% confidence interval: 1.07-1.43, P = 0.003) and NH/PI race was independently associated with higher mortality (Odds Ratio: 5.35, 95% confidence interval: 1.32-21.6, P = 0.019). There was no difference in complicated disease (abscess or perforation), use of laparoscopy, or ostomy creation among races.
Despite national efforts to achieve equity in healthcare, disparities persist in surgical outcomes for those with diverticulitis. Black and NH/PI race are independently associated with increased morbidity and mortality, respectively. Use of laparoscopy, however, is no longer different by race suggesting some gaps may be closing.
减少医疗保健差距已引起越来越多的全国关注。先前的研究表明，黑人憩室炎患者的手术结果更差，腹腔镜的使用也更少。尽管国家采取了改善健康公平的举措，但对这些差异仍缺乏重新评估。本研究旨在评估种族与急性憩室炎患者短期结果和手术方法的关系。
从 2015 年至 2019 年，国家外科质量改进计划数据库中查询了接受非选择性手术治疗急性憩室炎的患者。根据种族比较了疾病严重程度、发病率、死亡率、手术方法和造口术的创建。
在纳入的 13996 名患者中，82.4%为白人，7.6%为黑人，1.1%为亚裔，0.61%为美洲印第安人/阿拉斯加原住民，0.20%为夏威夷原住民/太平洋岛民（NH/PI）。总体 30 天发病率为 44.3%，30 天死亡率为 3.9%。在多变量逻辑回归分析中，与白人相比，黑人种族与较高的 30 天发病率独立相关（优势比：1.24，95%置信区间：1.07-1.43，P=0.003），NH/PI 种族与较高的死亡率独立相关（优势比：5.35，95%置信区间：1.32-21.6，P=0.019）。不同种族之间在复杂疾病（脓肿或穿孔）、腹腔镜使用或造口术创建方面没有差异。
尽管国家在医疗保健方面做出了实现公平的努力，但憩室炎患者的手术结果仍存在差异。黑人和 NH/PI 种族分别与发病率和死亡率的增加独立相关。然而，腹腔镜的使用不再因种族而异，这表明一些差距可能正在缩小。
