Sharath Sherene E, Balentine Courtney J, Berger David H, Zhan Min, Zamani Nader, Choi Justin Chin-Bong, Kougias Panos
Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY, 11203, USA.
Department of Epidemiology and Biostatistics, State University of New York, Downstate University of New York, Downstate Health Sciences University, Brooklyn, NY, 11203, USA.
J Racial Ethn Health Disparities. 2024 Sep 12. doi: 10.1007/s40615-024-02176-w.
Few large sample studies have examined whether disparities, as measured by the proxy of race/ethnicity, are observed in long-term mortality after high-risk operations performed in a United States national health system. We compared operation year-related mortality risk by race/ethnicity after high-risk operative interventions among patients receiving care within the VHA.
From the Veterans Affairs Corporate Data Warehouse and Surgical Quality Improvement Program, data were retrieved for 426,695 patients undergoing high-risk surgical procedures in non-cardiac, general, vascular, thoracic, orthopedic, neurosurgery, and genitourinary specialties between 2000 and 2018. Operation year was used as a surrogate measure of advances in technology and perioperative management. Underrepresented race/ethnicity groups were compared in a binary form with Caucasian/White race, as the reference category. The primary outcome was time to mortality, defined as death occurring at any time, due to any cause, during follow up, and after the initial, eligible surgery.
The median follow-up after 537,448 operations among 426,695 patients was 4.8 years. After adjustment for preoperative risk factors and demographics, long-term mortality risk decreased significantly to a hazard ratio of 0.96 (95% confidence interval, 0.962 to 0.964) over calendar time. Long-term mortality was not significantly higher among African Americans/Blacks compared to Caucasians/Whites (p = 0.22). Among Hispanics, differences in mortality risk favored Caucasians/Whites in the early years under study-a difference that dissipated as time progressed. In the most recent years, no difference in mortality was observed among Asian/Native Americans and Caucasians/Whites.
Risk-adjusted long-term mortality after high-risk operations among Veterans Affairs hospitals did not significantly vary between African Americans/Blacks, Hispanics, and Asian/Native Americans groups.
很少有大样本研究探讨在美国国家卫生系统中进行高风险手术后，以种族/族裔为代理指标衡量的差异是否会在长期死亡率中体现。我们比较了退伍军人健康管理局（VHA）接受治疗的患者在高风险手术干预后，按种族/族裔划分的与手术年份相关的死亡风险。
从退伍军人事务部企业数据仓库和手术质量改进项目中，检索了2000年至2018年间在非心脏、普通外科、血管外科、胸外科、骨科、神经外科和泌尿生殖专科接受高风险手术的426,695例患者的数据。手术年份被用作技术进步和围手术期管理进展的替代指标。将代表性不足的种族/族裔群体以二元形式与作为参考类别的白种人/白人种族进行比较。主要结局是死亡时间，定义为在随访期间以及初次符合条件的手术后，因任何原因在任何时间发生的死亡。
426,695例患者的537,448次手术后的中位随访时间为4.8年。在对术前风险因素和人口统计学进行调整后，长期死亡风险在日历时间内显著降低至风险比为0.96（95%置信区间，0.962至0.964）。与白种人/白人相比，非裔美国人/黑人的长期死亡率没有显著更高（p = 0.22）。在西班牙裔中，在研究的早期，死亡风险差异对白种人/白人有利——随着时间的推移这种差异逐渐消失。在最近几年，亚洲/美洲原住民和白种人/白人之间未观察到死亡率差异。
退伍军人事务部医院高风险手术后经风险调整的长期死亡率在非裔美国人/黑人、西班牙裔和亚洲/美洲原住民群体之间没有显著差异。
