Azin Arash, Hirpara Dhruvin H, Doshi Sachin, Chesney Tyler R, Quereshy Fayez A, Chadi Sami A
From the Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Surgical Oncology, Princess Margaret Hospital and University Health Network, Toronto, Ontario, Canada.
Ann Surg Open. 2020 Nov 20;1(2):e023. doi: 10.1097/AS9.0000000000000023. eCollection 2020 Dec.
To determine if Black race is associated with worse short-term postoperative morbidity and mortality when compared to White race in a contemporary, cross-specialty-matched cohort.
Growing evidence suggests poorer outcomes for Black patients undergoing surgery.
A retrospective analysis was conducted comprising of all patients undergoing surgery in the National Surgical Quality Improvement Program dataset between 2012 and 2018. One-to-one coarsened exact matching was conducted between Black and White patients. Primary outcome was rate of 30-day morbidity and mortality.
After 1:1 matching, 615,118 patients were identified. Black race was associated with increased rate of all-cause morbidity (odds ratio [OR] = 1.10, 95% confidence interval [CI] 1.08-1.13, < 0.001) and mortality (OR = 1.15, 95% CI 1.01-1.31, = 0.039). Black race was associated with increased risk of re-intubation (OR = 1.33, 95% CI 1.21-1.48, < 0.001), pulmonary embolism (OR = 1.55, 95% CI 1.40-1.71, < 0.001), failure to wean from ventilator for >48 hours (OR = 1.14, 95% CI 1.02-1.29, < 0.001), progressive renal insufficiency (OR = 1.63, 95% CI 1.43-1.86, < 0.001), acute renal failure (OR = 1.39, 95% CI 1.16-1.66, < 0.001), cardiac arrest (OR = 1.47, 95% CI 1.24-1.76 < 0.001), bleeding requiring transfusion (OR = 1.39, 95% CI 1.34-1.43, < 0.001), DVT/thrombophlebitis (OR = 1.24, 95% CI 1.14-1.35, < 0.001), and sepsis/septic shock (OR = 1.09, 95% CI 1.03-1.15, < 0.001). Black patients were also more likely to have a readmission (OR = 1.12, 95% CI 1.10-1.16, < 0.001), discharge to a rehabilitation center (OR = 1.73, 95% CI 1.66-1.80, < 0.001) or facility other than home (OR = 1.20, 95% CI 1.16-1.23, < 0.001).
This contemporary matched analysis demonstrates an association with increased morbidity, mortality, and readmissions for Black patients across surgical procedures and specialties.
在一个当代跨专业匹配队列中，确定与白人相比，黑人种族是否与术后短期发病率和死亡率更高相关。
越来越多的证据表明，接受手术的黑人患者预后较差。
对2012年至2018年期间国家外科质量改进计划数据集中所有接受手术的患者进行回顾性分析。对黑人和白人患者进行一对一的精确匹配。主要结局是30天发病率和死亡率。
经过1:1匹配后，共识别出615118例患者。黑人种族与全因发病率增加相关（优势比[OR]=1.10，95%置信区间[CI]1.08 - 1.13，P<0.001）以及死亡率增加相关（OR = 1.15，95%CI 1.01 - 1.31，P = 0.039）。黑人种族与再次插管风险增加相关（OR = 1.33，95%CI 1.21 - 1.48，P<0.001）、肺栓塞（OR = 1.55，95%CI 1.40 - 1.71，P<0.001）、机械通气超过48小时仍无法脱机（OR = 1.14，95%CI 1.02 - 1.29，P<0.001）、进行性肾功能不全（OR = 1.63，95%CI 1.43 - 1.86，P<0.001）、急性肾衰竭（OR = 1.39，95%CI 1.16 - 1.66，P<0.001）、心脏骤停（OR = 1.47，95%CI 1.24 - 1.76，P<0.001）、需要输血的出血（OR = 1.39，95%CI 1.34 - 1.43，P<0.001）、深静脉血栓形成/血栓性静脉炎（OR = 1.24，95%CI 1.14 - 1.35，P<0.001）以及脓毒症/脓毒性休克（OR = 1.09，95%CI 1.03 - 1.15，P<0.001）。黑人患者也更有可能再次入院（OR = 1.12，95%CI 1.10 - 1.16，P<0.001）、出院后前往康复中心（OR = 1.73，95%CI 1.66 - 1.80，P<0.001）或除家庭以外的其他机构（OR = 1.20，95%CI 1.16 - 1.23，P<0.001）。
这项当代匹配分析表明，黑人患者在各类外科手术和专业中，发病率、死亡率及再次入院率均有所增加。
