Skorochod Ron, Wolf Yoram
From the Plastic Surgery Unit, Hillel Yaffe Medical Center, Madera, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Plast Reconstr Surg Glob Open. 2024 Oct 9;12(10):e6220. doi: 10.1097/GOX.0000000000006220. eCollection 2024 Oct.
Racial disparities in surgical outcomes have been shown to lead to subpar results in various patients. Variability and contradictions in the current literature highlight the need for a crucial evaluation of the matter in studies focusing on plastic and reconstructive surgery. Investigating the matter is a pivotal step toward effective guidelines that mitigate factors contributing to racial disparities in outcomes and improve our perception of a patient-centered health-care system. The study aimed to identify whether racial disparities exist in plastic and reconstructive surgery procedures.
Systematic review of the literature as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find relevant articles assessing the impact of race on surgical outcomes. PubMed, Embase, MEDLINE, and Cochrane library were screened by both authors, and relevant articles were identified. Prevalence of complications were extracted from included studies, and odds ratio (OR) with 95% confidence interval (CI) was calculated and grouped for a statistical analysis.
Meta-analysis of 13 studies, with a mean of 8059 patients per study, demonstrated a pooled OR of 1.21 (95% CI: 1.00-1.46), indicating an insignificant association between non-White race and postoperative complications. Subanalysis comparing African American patients to White patients (10 studies) showed an OR of 1.36 (95% CI: 1.06-1.74), signifying a statistically significant risk for African Americans. No publication bias was observed, but substantial heterogeneity (73% and 79%) suggested varied study factors influencing outcomes.
Racial disparities exist in plastic and reconstructive outcomes. Physicians and medical staff should focus on patients' sociodemographic background, accessibility to care, support cycles, and language proficiency, while determining the surgical plan and postoperative care.
手术结果中的种族差异已被证明会导致不同患者的结果不尽人意。当前文献中的变异性和矛盾突出表明，在专注于整形和重建手术的研究中，有必要对这一问题进行关键评估。对这一问题进行调查是朝着制定有效指南迈出的关键一步，这些指南可减轻导致结果中种族差异的因素，并改善我们对以患者为中心的医疗保健系统的认知。该研究旨在确定整形和重建手术中是否存在种族差异。
按照系统评价和荟萃分析的首选报告项目指南对文献进行系统评价，以找到评估种族对手术结果影响的相关文章。两位作者均对PubMed、Embase、MEDLINE和Cochrane图书馆进行了筛选，并确定了相关文章。从纳入的研究中提取并发症的发生率，并计算95%置信区间（CI）的比值比（OR），并进行分组以进行统计分析。
对13项研究进行的荟萃分析，每项研究平均有8059名患者，结果显示合并OR为1.21（95%CI：1.00 - 1.46），表明非白人种族与术后并发症之间的关联不显著。将非裔美国患者与白人患者进行比较的亚分析（10项研究）显示OR为1.36（95%CI：1.06 - 1.74），这表明非裔美国人存在统计学上显著的风险。未观察到发表偏倚，但存在实质性异质性（73%和79%），这表明存在影响结果的各种研究因素。
整形和重建手术结果中存在种族差异。医生和医护人员在确定手术方案和术后护理时，应关注患者的社会人口背景、医疗可及性、支持周期和语言能力。
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