与儿童心脏手术不良预后相关的种族健康差异：一项多中心横断面研究。
Racial Health Disparity Associated With Poor Pediatric Cardiac Surgery Outcomes: A Multicentered, Cross-Sectional Study.
作者信息
Setty Shaun P, Reynolds Lauren C, Chou Vanessa C, Yu Maya T, Kang Stephen, Allen Phillip M, Tran Lan, Le Jennifer
机构信息
Division of Pediatric Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, California, USA.
Children's Heart Institute, MemorialCare Miller Children's and Women's Hospital, Long Beach, California, USA.
出版信息
JACC Adv. 2024 Jun 12;3(7):100987. doi: 10.1016/j.jacadv.2024.100987. eCollection 2024 Jul.
BACKGROUND
Health disparities are known to play a role in pediatric cardiac surgery outcomes.
OBJECTIVES
Risk factors associated with poor clinical outcomes were assessed.
METHODS
Using Pediatric Health Information System Database, pediatric subjects undergoing cardiac surgery using International Classification of Diseases 10th Revision from October 2015 to December 2020 were evaluated. Subjects were categorized by case complexity using the newly validated Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2). Multivariable regression analyses were conducted to ascertain risk factors.
RESULTS
A total of 59,856 subjects, median age 7.4 months (IQR: 1.5-61 months) were included; 38,917 (low), 9,833 (medium), and 11,106 (high) RACHS-2. Overall, hospital mortality was 3% and postoperative length of stay (LOS) was 7 days (IQR: 4-18 days), with significant increases in both mortality and postoperative LOS from low to high RACHS-2 scores by multivariable analysis, Kaplan-Meier, and Cox regression. Mechanical ventilation, extracorporeal membrane oxygenation, infection, and surgical complication were most significantly associated with increased mortality by 1.198 to 10.227 times ( < 0.008). After controlling for these significant variables as well as RACHS-2, age at surgery and emergency/urgent admission type, multivariable analysis revealed that non-White race was associated with increased mortality (relative risk: 1.2, 95% CI: 0.729-0.955, = 0.008) and increased postoperative LOS by 1.04 days (95% CI: 0.95-0.97, < 0.001). This significant increase in both clinical outcomes was concordant in non-White neonates (mortality relative risk: 1.3, 95% CI: 1.1-1.6, = 0.003; and postoperative LOS by 2.05 weeks (95% CI: 1.36-3.10, < 0.001).
CONCLUSIONS
The influence of racial differences in neonates and children should be further evaluated to mitigate any disparity in those undergoing cardiac surgery.
背景
已知健康差异在小儿心脏手术结果中起作用。
目的
评估与不良临床结果相关的风险因素。
方法
使用儿科健康信息系统数据库，对2015年10月至2020年12月期间使用国际疾病分类第10版进行心脏手术的儿科患者进行评估。使用新验证的先天性心脏病手术风险调整-2（RACHS-2）按病例复杂性对患者进行分类。进行多变量回归分析以确定风险因素。
结果
共纳入59856名患者，中位年龄7.4个月（四分位间距：1.5 - 61个月）；RACHS-2评分为低危38917例、中危9833例、高危11106例。总体而言，医院死亡率为3%，术后住院时间（LOS）为7天（四分位间距：4 - 18天），多变量分析、Kaplan-Meier分析和Cox回归显示，从低到高RACHS-2评分，死亡率和术后LOS均显著增加。机械通气、体外膜肺氧合、感染和手术并发症与死亡率增加最显著相关，增加1.198至10.227倍（P < 0.008）。在控制这些显著变量以及RACHS-2、手术年龄和急诊/紧急入院类型后，多变量分析显示非白人种族与死亡率增加相关（相对风险：1.2，95%置信区间：0.729 - 0.955，P = 0.008），术后LOS增加1.04天（95%置信区间：0.95 - 0.97，P < 0.001）。非白人新生儿的这两种临床结果的显著增加是一致的（死亡率相对风险：1.3，95%置信区间：1.1 - 1.6，P = 0.003；术后LOS增加2.05周（95%置信区间：1.36 - 3.10，P < 0.001）。
结论
应进一步评估新生儿和儿童种族差异的影响，以减轻心脏手术患者中的任何差异。
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