目的:评估接受头颈部重建手术患者种族差异的国家趋势。
方法:使用2008年至2021年美国外科医生学会国家外科质量改进计划数据库进行回顾性分析。接受微血管游离组织转移的患者符合纳入条件。排除儿科患者和非耳鼻喉科医师治疗的患者。用单变量和多变量模型分析结果。
结果:共分析5831例头颈部游离皮瓣,4869(83.5%)为白人,560人(9.6%)是黑人或非裔美国人,402人(6.9%)为亚洲人,美洲原住民,或其他团体(ANAOG)。在该时间段内,黑人或非裔美国人患者和接受游离组织转移的ANAOG患者的比例显着增加(分别为p=0.047和p=0.010)。然而,2017年左右开始出现下降趋势。在多变量模型中,黑人或非裔美国人种族与再入院无关(OR=0.99[95%CI0.74,1.31],P>0.05),返回手术室(OR=1.20[95%CI0.96,1.49],P>0.05),或任何术后并发症(OR=0.83[95%CI0.68,1.01],p>0.05)。在多变量分析中,ANAOG人群中也没有发现显著的相关性(均p>0.05)。
结论:在美国,少数背景的头颈癌患者中进行游离组织转移的百分比一直在增加。按种族分层时,头颈部微血管重建后的结果相似。然而,种族差异仍然存在,有必要进一步努力减少这些差异。
方法:四级喉镜,2024.
OBJECTIVE: To evaluate national trends in racial disparities for patients undergoing head and neck reconstructive surgery.
METHODS: Retrospective analysis using the 2008 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. Patients receiving microvascular free tissue transfer were eligible for inclusion. Pediatric patients and those treated by non-otolaryngologists were excluded. Outcomes were analyzed with univariate and multivariable models.
RESULTS: A total of 5831 head and neck free flap cases were analyzed, 4869 (83.5%) were White, 560 (9.6%) were Black or African American, and 402 (6.9%) were Asian, Native American, or other groups (ANAOG). The proportion of Black or African American patients and ANAOG patients undergoing free tissue transfer increased significantly over the time period (p = 0.047 and p = 0.010, respectively). However, there was a downtrend that started around 2017. In a multivariable model, Black or African American race was not associated with readmission (OR = 0.99 [95% CI 0.74, 1.31], p > 0.05), returning to the operating room (OR = 1.20 [95% CI 0.96, 1.49], p > 0.05), or any post-operative complication (OR = 0.83 [95% CI 0.68, 1.01], p > 0.05). There were also no significant associations found in the ANAOG population on multivariate analysis (p > 0.05 for all).
CONCLUSIONS: The percentage of free tissue transfer performed in patients from minority backgrounds with head and neck cancer has been increasing in the United States. Outcomes after head and neck microvascular reconstruction are similar when stratified by race. However, racial disparities remain and further work is necessary to reduce these disparities.
METHODS: Level IV Laryngoscope, 2024.