What Happens to Racial and Ethnic Minorities after Cancer Surgery at American College of Surgeons National Surgical Quality Improvement Program Hospitals?
What Happens to Racial and Ethnic Minorities after Cancer Surgery at American College of Surgeons National Surgical Quality Improvement Program Hospitals?
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DOI：
10.1016/j.jamcollsurg.2011.12.024
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发表时间：
2012-04-01
影响因子：
5.2
通讯作者：
Al-Refaie, Waddah B.
中科院分区：
文献类型：
--
作者：
Parsons, Helen M.;Habermann, Elizabeth B.;Al-Refaie, Waddah B.
背景：在美国，获得癌症治疗的机会不足导致了广泛的种族差异。然而，在追求质量的医院，如参加美国外科医师学会国家手术质量改进计划（ACS NSQIP）的医院，少数种族的结果仍然未知。我们假设在ACS NSQIP医院接受癌症手术后，少数种族和族裔患者的手术结果与白人患者相当。研究设计：使用2005-2008年ACS NSQIP数据，我们确定了38,926例接受胸部、腹部或盆腔癌手术的患者。我们使用多变量逻辑回归来检验种族和民族与癌症手术后短期（30天）手术结果之间的关系。进行敏感性分析以确保按程序分层后关系保持一致。结果：非白人患者占ACS NSQIP医院肿瘤手术患者的16.9%。尽管非白人患者更有可能有更高水平的合并症，接受更复杂的切除（p < 0.05），但多因素分析表明，这些患者在癌症手术后出现不良短期手术结果的可能性与白人患者相同。这些结果在手术程度分层后仍然存在。然而，黑人、西班牙裔和美洲印第安人/阿拉斯加原住民患者更有可能经历较长的住院时间（黑人与白人患者的优势比= 1.33;p < 0.001）。结论：在ACS NSQIP医院接受癌症手术的少数族裔患者的短期手术效果与白人患者相似，但他们的住院时间更长。这些发现表明，获得以质量为导向的医院可能会改善癌症治疗和结果的种族差异。未来的政策应侧重于扩大获得以质量为导向的手术设施的机会，作为及时和最佳癌症治疗的一步。[J]中华医学杂志，2012;14:539-549。(C) 2012年由美国外科医师学会发布)
BACKGROUND: Inadequate access has contributed to widespread racial disparities in cancer care in the United States. However, the outcomes for racial minorities at quality-seeking hospitals, such as those participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), remain unknown. We hypothesized that operative outcomes for racial and ethnic minority patients after cancer surgery at ACS NSQIP hospitals are comparable with those for white patients.STUDY DESIGN: Using the 2005-2008 ACS NSQIP data, we identified 38,926 patients who underwent thoracic, abdominal, or pelvic cancer surgery. We used multivariate logistic regression to examine the association between race and ethnicity and short-term (30-day) operative outcomes after cancer surgery. Sensitivity analyses were performed to ensure the relationship remained consistent after stratification by procedure.RESULTS: Nonwhite patients constituted 16.9% of patients treated for cancer surgery in ACS NSQIP hospitals. Although nonwhite patients were more likely to have higher levels of comorbidities and undergo more complex resections (p < 0.05 for all), multivariate analyses demonstrated that these patients were as likely as white patients to have adverse short-term operative outcomes develop after cancer surgery. These results persisted after stratification by extent of surgical procedure. However, black, Hispanic, and American-Indian/Alaskan-Native patients were more likely to experience prolonged length of stay (odds ratio for black vs white patients = 1.33; p < 0.001).CONCLUSIONS: Racial and ethnic minority patients who undergo their cancer surgery at ACS NSQIP hospitals have short-term operative outcomes similar to white patients, but they remain hospitalized longer. These findings suggest that access to quality-driven hospitals might ameliorate racial disparities in cancer care and outcomes. Future policies should focus on expanding access to quality-driven surgical facilities as a step toward timely and optimal cancer care. (J Am Coll Surg 2012; 214: 539-549. (C) 2012 by the American College of Surgeons)