UCSF Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Vasc Surg Venous Lymphat Disord. 2024 Jul;12(4):101867. doi: 10.1016/j.jvsv.2024.101867. Epub 2024 Mar 5.
The goal of this study was to analyze trends in treatment access for chronic superficial venous disease and to identify disparities in care.
This retrospective study was exempt from institutional review board approval. The American College of Surgeon National Surgical Quality Improvement Program database was used to identify patients who underwent vein stripping (VS) and endovenous procedures for treatment of chronic superficial venous disease. Endovenous options included radiofrequency ablation (RFA) and laser ablation. Data was available from 2011 to 2018 and demographic information was extracted for each patient identified by Current Procedural Terminology codes. For all racial and ethnic groups, trend lines were plotted, and the relative rate of change was determined within each specified demographic.
There were 21,025 patients included in the analysis. The overall mean age was 54.2 years, and the majority of patients were female (64.8%). In total, 27.9%, 55.2%, and 16.9% patients underwent VS, RFA, and laser ablation, respectively. Patients who received laser ablation were older (P < .001). Hispanic ethnicity was associated with significantly lower odds of receiving endovascular thermal ablation (EVTA) over VS (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.64-0.78; P < .001). American Indian/Alaska Native patients were more likely to receive EVTA over VS (OR, 4.02; 95% CI, 2.48-6.86); similarly, Native Hawaiian/Pacific Islander patients were more likely to receive EVTA over VS, although this difference was not statistically significant (OR, 1.44; 95% CI, 0.93-2.27). On multinomial regression, Hispanic patients were less likely to receive RFA over VS, whereas American Indian/Alaskan Native patients were more likely to receive RFA over VS. In all racial and ethnic groups, the percentage of endovenous procedures increased, whereas vein stripping decreased.
Based on a hospital-based dataset, demographic indicators, including age, sex, race, and ethnicity, are associated with differences in endovenous treatments for chronic superficial venous insufficiency suggesting disparities in obtaining minimally invasive treatment options among certain patient groups.
本研究旨在分析慢性浅静脉疾病治疗途径的变化趋势，并确定治疗中的差异。
本回顾性研究获得机构审查委员会豁免批准。使用美国外科医师学院国家手术质量改进计划数据库，确定接受静脉剥离术（VS）和静脉内治疗慢性浅静脉疾病的患者。静脉内治疗包括射频消融（RFA）和激光消融。数据可获得自 2011 年至 2018 年，通过当前操作术语代码为每个患者提取人口统计学信息。对所有种族和族裔群体，绘制趋势线，并确定每个特定人群中变化的相对比率。
分析中纳入 21025 例患者。总体平均年龄为 54.2 岁，大多数患者为女性（64.8%）。总共分别有 27.9%、55.2%和 16.9%的患者接受了 VS、RFA 和激光消融。接受激光消融的患者年龄较大（P<.001）。与接受 VS 相比，西班牙裔患者接受血管内热消融（EVTA）的可能性显著降低（比值比[OR]，0.71；95%置信区间[CI]，0.64-0.78；P<.001）。美国印第安人/阿拉斯加原住民患者更有可能接受 EVTA 而非 VS（OR，4.02；95%CI，2.48-6.86）；同样，夏威夷原住民/太平洋岛民患者也更有可能接受 EVTA 而非 VS，尽管这一差异无统计学意义（OR，1.44；95%CI，0.93-2.27）。在多变量回归中，西班牙裔患者接受 RFA 而非 VS 的可能性降低，而美国印第安人/阿拉斯加原住民患者接受 RFA 而非 VS 的可能性增加。在所有种族和族裔群体中，静脉内治疗的比例增加，而静脉剥离术的比例下降。
基于医院数据库，人口统计学指标，包括年龄、性别、种族和族裔，与慢性浅静脉功能不全的静脉内治疗差异相关，这表明某些患者群体在获得微创治疗选择方面存在差异。
