PDF(Pubmed)
Abstract：
Surgical interventions are common among seriously ill older patients, with nearly one-third of older Americans facing surgery in their last year of life. Despite the potential benefits of palliative care among older surgical patients undergoing high-risk surgical procedures, palliative care in this population is underutilized and little is known about potential disparities by race/ethnicity and how frailty my affect such disparities. The aim of this study was to examine disparities in palliative care consultations by race/ethnicity and assess whether patients\' frailty moderated this association. Drawing on a retrospective cross-sectional study of inpatient surgical episodes using the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2005 to 2019, we found that frail Black patients received palliative care consultations least often, with the largest between-group adjusted difference represented by Black-Asian/Pacific Islander frail patients of 1.6 percentage points, controlling for sociodemographic, comorbidities, hospital characteristics, procedure type, and year. No racial/ethnic difference in the receipt of palliative care consultations was observed among nonfrail patients. These findings suggest that, in order to improve racial/ethnic disparities in frail older patients undergoing high-risk surgical procedures, palliative care consultations should be included as the standard of care in clinical care guidelines.
摘要：
手术干预在重症老年患者中很常见，近三分之一的美国老年人在生命的最后一年面临手术。尽管在接受高风险外科手术的老年手术患者中，姑息治疗具有潜在的益处，该人群的姑息治疗未得到充分利用，对种族/民族的潜在差异以及虚弱如何影响这种差异知之甚少。这项研究的目的是检查种族/民族在姑息治疗咨询中的差异，并评估患者的虚弱是否减轻了这种联系。利用2005年至2019年医疗保健成本和利用项目的全国住院患者样本对住院手术发作进行的回顾性横断面研究，我们发现体弱的黑人患者接受姑息治疗咨询的次数最少，以黑人-亚洲/太平洋岛民体弱患者为代表的最大组间调整后差异为1.6个百分点，控制社会人口统计学，合并症,医院特色,程序类型,和年份。在非虚弱患者中，接受姑息治疗咨询的种族/种族差异未观察到。这些发现表明,为了改善接受高风险外科手术的虚弱老年患者的种族/族裔差异，姑息治疗咨询应作为临床护理指南中的标准护理.
