Department of Surgery State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Surgery State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
Am J Surg. 2024 Nov;237:115909. doi: 10.1016/j.amjsurg.2024.115909. Epub 2024 Aug 17.
We examined whether hospital resources mediated the association between race/ethnicity and postoperative VTE, in a national cohort.
National Inpatient Sample data were restricted to major abdominal surgeries (1993-2020) performed for malignancies. Hospital resource index was as a summary measure of hospital size, teaching status, and private payor proportions. The composite VTE outcome included postoperative deep vein thrombosis and pulmonary embolism. Adjusted logistic regression with 4-way decomposition described joint and mediating effects.
Among 1,169,862 surgeries, unadjusted VTE rate was 1.0 % (14,789). VTE risk was 28 % higher for Black/African Americans (adjusted Odds Ratio = 1.28, 95 % CI: 1.21, 1.37) relative to White/Caucasians. VTE risk was lower among Black individuals as hospital resource index increased (excess risk = -0.005, p < 0.001), with an effect size of likely minimal clinical impact.
Cohorts that are more vulnerable to postoperative VTE did not meaningfully benefit from improving hospital resources. It is likely that lifestyle modifying behaviors, environmental factors, and comorbidity management are more influential in reducing risks.
我们研究了在全国队列中，医院资源是否在种族/民族与术后静脉血栓栓塞症之间的关联中起中介作用。
国家住院患者样本数据仅限于为恶性肿瘤进行的主要腹部手术（1993-2020 年）。医院资源指数是医院规模、教学地位和私人支付者比例的综合衡量指标。复合 VTE 结局包括术后深静脉血栓形成和肺栓塞。使用 4 路分解的调整后逻辑回归描述了联合和中介作用。
在 1,169,862 例手术中，未经调整的 VTE 发生率为 1.0%（14,789）。与白人/高加索人相比，黑人/非裔美国人（调整后的优势比 = 1.28，95%可信区间：1.21, 1.37）的 VTE 风险高 28%。随着医院资源指数的增加，黑人个体的 VTE 风险降低（超额风险 = -0.005，p<0.001），其效应大小可能具有最小的临床意义。
术后 VTE 风险更高的队列并没有从改善医院资源中获得实质性的益处。更有可能的是，改变生活方式的行为、环境因素和合并症管理在降低风险方面更具影响力。
