Olecki Elizabeth J, Perez Holguin Rolfy A, Mayhew Mackenzie M, Wong William G, Vining Charles C, Peng June S, Shen Chan, Dixon Matthew E B
Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
J Surg Res. 2024 Feb;294:160-168. doi: 10.1016/j.jss.2023.09.066. Epub 2023 Oct 26.
Minority serving hospitals (MSH) are those serving a disproportionally high number of minority patients. Previous research has demonstrated that treatment at MSH is associated with worse outcomes. We hypothesize that patients treated at MSH are less likely to undergo surgical resection of pancreatic adenocarcinoma compared to patients treated at non-MSH.
Patients with resectable pancreatic cancer were identified using the National Cancer Database. Institutions treating Black and Hispanic patients in the top decile were categorized as an MSH. Factors associated with the primary outcome of definitive surgical resection were evaluated using multivariable logistic regression. Univariate and multivariable survival analysis was performed.
Of the 75,513 patients included in this study, 7.2% were treated at MSH. Patients treated at MSH were younger, more likely to be uninsured, and higher stage compared to those treated at non-MSH (P < 0.001). Patients treated at MSH underwent surgical resection at lower rates (MSH 40% versus non-MSH 44.5%, P < 0.001). On multivariable logistic regression, treatment at MSH was associated with decreased likelihood of undergoing definitive surgery (odds ratio 0.91, P = 0.006). Of those who underwent surgical resection, multivariable survival analysis revealed that treatment at an MSH was associated with increased morality (hazard ratio 1.12, P < 0.001).
Patients with resectable pancreatic adenocarcinoma treated at MSH are less likely to undergo surgical resection compared to those treated at non-MSH. Targeted interventions are needed to address the unique barriers facing MSH facilities in providing care to patients with pancreatic adenocarcinoma.
少数族裔服务医院（MSH）是指为数量不成比例的少数族裔患者提供服务的医院。先前的研究表明，在MSH接受治疗与更差的治疗结果相关。我们假设，与在非MSH接受治疗的患者相比，在MSH接受治疗的患者接受胰腺腺癌手术切除的可能性更小。
使用国家癌症数据库识别可切除胰腺癌患者。将治疗黑人和西班牙裔患者数量处于前十分位的机构归类为MSH。使用多变量逻辑回归评估与确定性手术切除这一主要结局相关的因素。进行单变量和多变量生存分析。
本研究纳入的75513例患者中，7.2%在MSH接受治疗。与在非MSH接受治疗的患者相比，在MSH接受治疗的患者更年轻，更可能未参保，且分期更高（P<0.001）。在MSH接受治疗的患者接受手术切除的比例较低（MSH为40%，非MSH为44.5%，P<0.001）。在多变量逻辑回归中，在MSH接受治疗与接受确定性手术的可能性降低相关（比值比为0.91，P=0.006）。在接受手术切除的患者中，多变量生存分析显示，在MSH接受治疗与死亡率增加相关（风险比为1.12，P<0.001）。
与在非MSH接受治疗的患者相比，在MSH接受治疗的可切除胰腺腺癌患者接受手术切除的可能性更小。需要有针对性的干预措施来解决MSH机构在为胰腺腺癌患者提供护理方面面临的独特障碍。
