Abstract：
Introduction: Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. Methods: All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample. Patients were stratified by Black or White race. To consider the evolution in outcomes, we included an interaction term between race and year. We designated centers in the top quartile of annual procedural volume as high-volume hospitals (HVH). Results: Of ∼2,838,485 patients, 245,405 (8.6%) were of Black race. Following risk-adjustment, Black race was linked with similar odds of in-hospital mortality, but increased likelihood of major complications (Adjusted Odds Ratio [AOR] 1.41, 95%Confidence Interval [CI] 1.36-1.47). From 2016-2020, overall risk-adjusted rates of major complications declined (patients of White race: 9.2% to 8.4%; patients of Black race 11.8% to 10.8%, both P < .001). Yet, the delta in risk of adverse outcomes between patients of White and Black race did not significantly change. Of the cohort, 158,060 (8.4%) were treated at HVH. Following adjustment, Black race remained associated with greater odds of morbidity (AOR 1.37, CI 1.23-1.52; Ref:White). The race-based difference in risk of complications at HVH did not significantly change from 2016 to 2020. Conclusion: While overall rates of complications following major elective procedures declined from 2016 to 2020, patients of Black race faced persistently greater risk of adverse outcomes. Novel interventions are needed to address persistent racial disparities and ensure acceptable outcomes for all patients.
摘要：
导言:尽管国家相当重视，手术结局的种族差异仍然存在.我们试图考虑在当代进行重大择期手术后基于种族的结果不平等是否有所改善。方法：所有成人择期冠状动脉旁路移植术住院记录，腹主动脉瘤修复术，结肠切除术,和髋关节置换的数据来自2016-2020年全国住院患者样本。患者按黑人或白人种族分层。为了考虑结果的演变，我们加入了种族和年份之间的相互作用术语。我们将年度手术量最高的四分位数的中心指定为高容量医院（HVH）。结果：在~2,838,485例患者中，245,405（8.6％）属于黑人种族。风险调整后，黑人种族与医院内死亡率的几率相似，但主要并发症的可能性增加(调整后的赔率比[AOR]1.41,95%置信区间[CI]1.36-1.47)。从2016年至2020年，主要并发症的总体风险调整率下降（白种人：9.2％至8.4％；黑种人11.8％至10.8％，两者P<.001)。然而，白种人和黑种人患者的不良结局风险增量没有显著变化.在队列中，在HVH下处理158,060(8.4%)。调整后,黑人种族仍然与更高的发病率相关（AOR1.37，CI1.23-1.52；参考：白色）。从2016年到2020年，HVH并发症风险的种族差异没有显着变化。结论：虽然从2016年到2020年，主要选择性手术后的并发症总体发生率有所下降，但黑人患者面临的不良结局风险持续增加。需要新的干预措施来解决持续的种族差异，并确保所有患者的可接受结果。
