1Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
2Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
J Natl Compr Canc Netw. 2024 Oct 22;22(9):610-616. doi: 10.6004/jnccn.2024.7038.
Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a "textbook outcome" (TO) following a cancer operation among a nationally representative cohort of patients.
Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression.
Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46-0.53; P<.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43-1.64), extended length of stay (OR, 2.06; 95% CI, 1.93-2.21), 90-day readmission (OR, 1.15; 95% CI, 1.07-1.24), 90-day mortality (OR, 1.90; 95% CI, 1.70-2.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97-4.62) (all P<.001).
Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.
智力和发育障碍（IDD）患者面临着独特的挑战，导致他们在医疗保健方面存在差异。我们旨在确定 IDD 对全国代表性癌症手术患者达到“教科书结局”（TO）的影响。
从 2014 年至 2020 年，从 100%的医疗保险标准分析文件数据库中提取接受恶性肿瘤手术治疗的患者的数据，包括肺癌、乳腺癌、肝癌、胆道癌、胰腺癌和结直肠癌。使用多变量逻辑回归评估 IDD 与 TO（定义为无术后并发症、延长住院时间、90 天再入院和 90 天死亡率）、支出和出院状态之间的关联。
在 500472 名 Medicare 受益人中，4326 名（0.9%）有 IDD，患有癌症（乳腺癌，n=481；肺癌，n=419；肝胆癌，n=194；胰腺癌，n=145；结直肠癌，n=3087）。尽管总体 TO 发生率为 50.5%，但与无 IDD 的患者相比，有 IDD 的患者更不可能达到 TO（分别为 37.1%和 50.6%；优势比[OR]，0.50；95%置信区间[CI]，0.46-0.53；P<.001）。在多变量回归中，有 IDD 的患者术后并发症（OR，1.53；95%CI，1.43-1.64）、延长住院时间（OR，2.06；95%CI，1.93-2.21）、90 天再入院（OR，1.15；95%CI，1.07-1.24）、90 天死亡率（OR，1.90；95%CI，1.70-2.13）和出院到熟练护理机构（OR，4.28；95%CI，3.97-4.62）的可能性更高（均 P<.001）。
有 IDD 的患者术后达到 TO 的机会要低得多，而且出院到非家庭环境的可能性也更高。数据强调需要改善 IDD 患者的护理，以确保公平的肿瘤外科护理。
