背景:文献中已经很好地描述了急诊普外科(EGS)患者的种族和种族差异。尽管如此,这些差距的负担,特别是在更脆弱的老年人口中,相对未知。本研究旨在调查老年EGS患者临床结果的种族和种族差异。
方法:本回顾性分析使用2013年至2019年美国外科医生学会国家外科质量改进计划数据库的数据。包括65岁或以上的EGS患者。根据患者自我报告的种族和种族对患者进行分类。评估的主要结果是住院死亡率,30天死亡率,和总体发病率。进行多变量逻辑回归以检查种族/民族与术后结局之间的关系,同时调整相关因素,包括年龄,合并症,功能状态,术前情况,和外科手术。
结果:共纳入54,132例患者,其中79.8%被认定为非西班牙裔白人,9.5%为非西班牙裔黑人(NHB),5.8%是西班牙裔,4.2%为非西班牙裔亚洲人。风险调整后,与非西班牙裔白人患者相比,NHB,非西班牙裔亚洲人,西班牙裔患者30d死亡率降低.对于30天的再入院和再手术,组间差异具有可比性.然而,NHB患者的总体发病率几率显著增加(调整后的优势比,1.18;95%置信区间:1.10-1.26;P<0.001)和术后并发症包括脓毒症,静脉血栓栓塞,和计划外的插管.西班牙裔种族与术后心肌梗死和中风的几率较低相关。
结论:在接受急诊普外科手术的老年患者中,少数民族患者的发病率较高,但发现了死亡率的矛盾差异。需要进一步的研究来确定这些差异的原因,并制定有针对性的干预措施来消除这些差异。
BACKGROUND: Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS.
METHODS: This retrospective analysis used data from 2013 to 2019 American College of Surgeons National Surgery Quality Improvement Program database. EGS patients aged 65 y or older were included. Patients were categorized based on their self-reported race and ethnicity. The primary outcomes evaluated were in-hospital mortality, 30-d mortality, and overall morbidity. Multivariable logistic regression was performed to examine the relationship between race/ethnicity and postoperative outcomes while adjusting for relevant factors including age, comorbidities, functional status, preoperative conditions, and surgical procedure.
RESULTS: A total of 54,132 patients were included, of whom 79.8% identified as non-Hispanic White, 9.5% as non-Hispanic Black (NHB), 5.8% as Hispanic, and 4.2% as non-Hispanic Asian. After risk adjustment, compared to non-Hispanic White patients, NHB, non-Hispanic Asian, and Hispanic patients had decreased odds of 30-d mortality. For 30-d readmission and reoperation, differences among groups were comparable. However, NHB patients had significantly increased odds of overall morbidity (adjusted odds ratio, 1.18; 95% confidence interval: 1.10-1.26; P < 0.001) and postoperative complications including sepsis, venous thromboembolism, and unplanned intubation. Hispanic ethnicity was associated with lower odds of postoperative myocardial infarction and stroke.
CONCLUSIONS: Among older adult patients undergoing emergency general surgery, minority patients experienced higher morbidity rates, but paradoxical disparities in mortality were detected. Further research is necessary to identify the cause of these disparities and develop targeted interventions to eliminate them.