Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Am J Surg. 2024 Feb;228:11-19. doi: 10.1016/j.amjsurg.2023.08.003. Epub 2023 Aug 12.
We sought to determine the association of persistent poverty on patient outcomes relative to US News World Report (USNWR) rankings among individuals undergoing common major surgical procedures.
Medicare beneficiaries who underwent AAA repair, CABG, colectomy, or lung resection were identified. Multivariable logistic regression was used to evaluate the relationship between care at USNWR hospitals, county-level duration of poverty (never-high poverty (NHP); intermittent high poverty (IHP): persistent-poverty (PP)) and 30-day mortality.
Among 916,164 beneficiaries, individuals residing in PP neighborhoods who received surgical care at ranked hospitals had lower risk-adjusted 30-day mortality (5.89% vs 8.89%; p < 0.001). On multivariable analysis, 30-day mortality was lower at ranked hospitals across all poverty categories with greatest decrease among patients from PP regions (NHP: OR-0.91, 95%CI0.87-0.95; IHP: OR-0.78, 95%CI0.69-0.88; PP: OR-0.69, 95%CI0.57-0.83; p < 0.001).
Receipt of surgical care at top-ranked hospitals was associated with improvement in postoperative mortality, especially among patients residing in persistent poverty..
我们旨在确定在接受常见主要手术的患者中，与美国新闻与世界报道（USNWR）排名相比，持续贫困对患者结局的影响。
确定接受 AAA 修复术、CABG、结肠切除术或肺切除术的 Medicare 受益人的信息。采用多变量逻辑回归来评估 USNWR 医院护理、县级贫困持续时间（从未处于高贫困状态（NHP）；间歇性高贫困（IHP）：持续贫困（PP））与 30 天死亡率之间的关系。
在 916164 名受益人中，在排名医院接受手术治疗的居住在 PP 社区的个体，其风险调整后 30 天死亡率较低（5.89%比 8.89%；p < 0.001）。在多变量分析中，在所有贫困类别中，排名医院的 30 天死亡率均较低，其中来自 PP 地区的患者下降幅度最大（NHP：OR-0.91，95%CI0.87-0.95；IHP：OR-0.78，95%CI0.69-0.88；PP：OR-0.69，95%CI0.57-0.83；p < 0.001）。
在顶级医院接受手术治疗与术后死亡率的改善相关，特别是对于居住在持续贫困中的患者。
