Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Disabil Health J. 2024 Jul;17(3):101586. doi: 10.1016/j.dhjo.2024.101586. Epub 2024 Jan 23.
Despite the high prevalence of disability conditions in the US, their association with access to minimally invasive surgery (MIS) remains under-characterized.
To understand the association of disability conditions with rates of MIS and describe nationwide temporal trends in MIS in patients with disability conditions.
We conducted a retrospective cohort study using the Nationwide Readmission Database (2016-2019). We included patients ≥18 years undergoing general surgery procedures. Our primary outcome was the impact of disability conditions on the rate of MIS. We performed 1:1 propensity matching, comparing patients with disability conditions with those without and adjusting for patient, procedure, and hospital characteristics. We performed a subgroup analysis among patients<65 years and with patients with each type of disability. We evaluated temporal trends of MIS in patients with disabilities. We identified predictors of undergoing MIS using mixed effects regression analysis.
In the propensity-matched comparison, a lower proportion of patients with disabilities had MIS. In the sub-group analyses, the rate of MIS was significantly lower in patients below 65 years with disabilities and among patients with motor and intellectual impairments. There was an increasing trend in the proportion of patients with disabilities undergoing MIS (p < 0.005). The regression analysis confirmed that the presence of a disability was associated with decreased odds of undergoing MIS.
This study characterizes the negative association of disability conditions with access to MIS. As the healthcare landscape evolves, considerations on how to equitably share new treatment modalities with a wide range of patient populations are necessary.
尽管残疾在美国的患病率很高，但残疾与微创手术（MIS）的获得之间的关联仍未得到充分描述。
了解残疾状况与 MIS 率的关联，并描述残疾患者中 MIS 的全国性时间趋势。
我们使用全国再入院数据库（2016-2019 年）进行了回顾性队列研究。我们纳入了接受普通外科手术的年龄≥18 岁的患者。我们的主要结局是残疾状况对 MIS 率的影响。我们进行了 1:1 的倾向评分匹配，将残疾患者与无残疾患者进行比较，并调整了患者、手术和医院特征。我们在年龄<65 岁的患者和每种类型残疾的患者中进行了亚组分析。我们评估了残疾患者 MIS 的时间趋势。我们使用混合效应回归分析确定接受 MIS 的预测因素。
在倾向评分匹配比较中，残疾患者中接受 MIS 的比例较低。在亚组分析中，残疾且年龄<65 岁的患者以及患有运动和智力障碍的患者中，接受 MIS 的比例明显较低。接受 MIS 的残疾患者比例呈上升趋势（p<0.005）。回归分析证实，残疾的存在与接受 MIS 的可能性降低相关。
这项研究描述了残疾状况与获得 MIS 的负面关联。随着医疗保健领域的发展，有必要考虑如何公平地与广泛的患者群体共享新的治疗模式。
