Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Res. 2024 Sep;301:674-680. doi: 10.1016/j.jss.2024.07.084. Epub 2024 Aug 17.
Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS.
This retrospective analysis used data from 2013 to 2019 American College of Surgeons National Surgery Quality Improvement Program database. EGS patients aged 65 y or older were included. Patients were categorized based on their self-reported race and ethnicity. The primary outcomes evaluated were in-hospital mortality, 30-d mortality, and overall morbidity. Multivariable logistic regression was performed to examine the relationship between race/ethnicity and postoperative outcomes while adjusting for relevant factors including age, comorbidities, functional status, preoperative conditions, and surgical procedure.
A total of 54,132 patients were included, of whom 79.8% identified as non-Hispanic White, 9.5% as non-Hispanic Black (NHB), 5.8% as Hispanic, and 4.2% as non-Hispanic Asian. After risk adjustment, compared to non-Hispanic White patients, NHB, non-Hispanic Asian, and Hispanic patients had decreased odds of 30-d mortality. For 30-d readmission and reoperation, differences among groups were comparable. However, NHB patients had significantly increased odds of overall morbidity (adjusted odds ratio, 1.18; 95% confidence interval: 1.10-1.26; P < 0.001) and postoperative complications including sepsis, venous thromboembolism, and unplanned intubation. Hispanic ethnicity was associated with lower odds of postoperative myocardial infarction and stroke.
Among older adult patients undergoing emergency general surgery, minority patients experienced higher morbidity rates, but paradoxical disparities in mortality were detected. Further research is necessary to identify the cause of these disparities and develop targeted interventions to eliminate them.
在急诊普通外科（EGS）患者中，种族和民族差异已经在文献中得到了充分描述。尽管如此，这些差异的负担，特别是在更脆弱的老年人群中，相对来说还不为人知。本研究旨在调查老年 EGS 患者的临床结局中的种族和民族差异。
本回顾性分析使用了 2013 年至 2019 年美国外科医师学会国家手术质量改进计划数据库的数据。纳入年龄在 65 岁或以上的 EGS 患者。患者根据自我报告的种族和族裔进行分类。主要结局评估包括院内死亡率、30 天死亡率和总发病率。多变量逻辑回归用于检查种族/民族与术后结局之间的关系，同时调整了年龄、合并症、功能状态、术前情况和手术程序等相关因素。
共纳入 54132 名患者，其中 79.8%为非西班牙裔白人，9.5%为非西班牙裔黑人（NHB），5.8%为西班牙裔，4.2%为非西班牙裔亚裔。在风险调整后，与非西班牙裔白人患者相比，NHB、非西班牙裔亚裔和西班牙裔患者的 30 天死亡率降低。对于 30 天再入院和再次手术，各组之间的差异相当。然而，NHB 患者的总发病率显著增加（调整后的优势比，1.18；95%置信区间：1.10-1.26；P<0.001），并伴有术后并发症，包括败血症、静脉血栓栓塞和非计划性插管。西班牙裔与术后心肌梗死和中风的几率降低相关。
在接受急诊普通外科手术的老年患者中，少数民族患者的发病率较高，但死亡率却存在反常的差异。需要进一步研究以确定这些差异的原因，并制定有针对性的干预措施来消除这些差异。
