Ismayl Mahmoud, Ahmed Hasaan, Goldsweig Andrew M, Alkhouli Mohamad, Guerrero Mayra
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Internal Medicine, Creighton University, Omaha, NE.
Ann Med Surg (Lond). 2024 Jun 19;86(8):4368-4376. doi: 10.1097/MS9.0000000000002203. eCollection 2024 Aug.
Data on racial/ethnic and sex disparities in the utilization and outcomes of tricuspid valve surgery (TVS) in the United States are scarce. The authors aimed to evaluate the impact of race/ethnicity and sex on the utilization and outcomes of TVS.
The authors analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for TVS. Racial/ethnic and sex disparities in TVS outcomes were determined using logistic regression models.
Between 2016 and 2020, 19 395 hospitalizations for TVS were identified. The utilization rate (number of surgeries/100,000 hospitalizations) was lower in Black and Hispanic patients compared with White patients for surgical tricuspid valve repair (STVr) (331 versus 493 versus 634, <0.01) and surgical tricuspid valve replacement (STVR) (312 versus 601 versus 728, <0.01). Similarly, the utilization rate was lower for women compared with men for STVr (1021 versus 1364, <0.01) and STVR (930 versus 1,316, <0.01). Compared to White men undergoing TVS, all women had lower odds of acute kidney injury [adjusted odds ratio (aOR) 0.65, 95% CI 0.55-0.78] and higher odds of blood transfusion (aOR 1.30, 95% CI 1.07-1.59), and Black men had higher odds of blood transfusion (aOR 1.59, 95% CI 1.08-2.35). In-hospital mortality and other surgical complications were similar between all groups (all >0.05).
Significant racial/ethnic and sex disparities exist in the utilization of TVS in the United States. Further studies are needed to understand the reasons for these disparities and to identify effective strategies for their mitigation.
美国三尖瓣手术（TVS）在使用情况和治疗结果方面的种族/族裔及性别差异数据匮乏。作者旨在评估种族/族裔和性别对TVS使用情况及治疗结果的影响。
作者分析了2016年至2020年的全国住院患者样本数据库，以确定TVS住院病例。使用逻辑回归模型确定TVS治疗结果中的种族/族裔及性别差异。
2016年至2020年期间，共确定了19395例TVS住院病例。与白人患者相比，黑人和西班牙裔患者进行三尖瓣手术修复（STVr）（331对493对634，<0.01）和三尖瓣置换术（STVR）（312对601对728，<0.01）的使用率（手术例数/100,000例住院病例）较低。同样，女性进行STVr（1021对1364，<0.01）和STVR（930对1316，<0.01）的使用率也低于男性。与接受TVS的白人男性相比，所有女性发生急性肾损伤的几率较低[调整优势比（aOR）0.65，95%置信区间0.55 - 0.78]，输血几率较高（aOR 1.30，95%置信区间1.07 - 1.59），黑人男性输血几率较高（aOR 1.59，95%置信区间1.08 - 2.35）。所有组之间的住院死亡率和其他手术并发症相似（均>0.05）。
美国在TVS的使用方面存在显著的种族/族裔和性别差异。需要进一步研究以了解这些差异的原因，并确定减轻这些差异的有效策略。
