Scott Shane S, Gouchoe Doug A, Azap Lovette, Henn Matthew C, Choi Kukbin, Mokadam Nahush A, Whitson Bryan A, Pawlik Timothy M, Ganapathi Asvin M
Medical Scientist Training Program, Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH USA.
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA.
Curr Cardiovasc Risk Rep. 2024;18(7):95-113. doi: 10.1007/s12170-024-00739-4. Epub 2024 Jul 29.
Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support.
Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics.
Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.
尽管人们努力减少种族因素对医疗的影响,但种族仍然是心脏手术后发病和死亡的一个重要风险因素。虽然来自种族和少数族裔群体的患者在心脏手术中的占比不足,但他们在各种心脏手术过程中经历的不良后果数量却不成比例地增加。本综述总结了现有文献,突出了冠状动脉搭桥手术、瓣膜手术、心脏移植和机械循环支持方面的差异。
不幸的是,由于种族与术后结果之间的复杂关系,即使在大型多中心研究中,这些差异的具体原因也可能难以确定。目前的数据表明,这些种族/族裔差异可归因于患者、社会经济和医院环境特征的综合作用。
为对抗观察到的不同结果背后的机制而提出的解决方案,需要部署一个由心脏病专家、麻醉师、心脏外科医生以及医疗公平和医学伦理专家组成的多学科团队。成功识别高危人群并实施预防措施是消除心脏手术结果中种族/族裔差异的必要第一步。