Racial Disparity in 30-Day Morbidity and Mortality After Surgery for Ovarian Cancer
Racial Disparity in 30-Day Morbidity and Mortality After Surgery for Ovarian Cancer
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DOI：
10.1097/igc.0000000000000324
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发表时间：
2015-01-01
影响因子：
4.8
通讯作者：
Rose, Peter G.
中科院分区：
文献类型：
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作者：
Mahdi, Haider;Jernigan, Amelia;Rose, Peter G.
背景资料：近年来，与白色（W）女性相比，非洲裔美国人（AA）女性卵巢癌（OC）患者的生存率有所提高。术后即刻发病率和死亡率对这种生存差异的影响尚不清楚。本研究旨在探讨术后30天的发病率和死亡率之间的差距AA和W妇女OC.材料和方法：OC患者被确定为美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）2005年至2011年。研究了非裔美国人和亚组。结果：1649例女性中，W1510例（92%），AA 139例（8%）。整个队列的术后30天并发症发生率和死亡率分别为30%和2%。AA和W女性的术后并发症无差异（33% vs 30%，P = 0.47），包括手术（29% vs 26%，P = 0.40）和非手术（10% vs 9%，P = 0.75）并发症。AA女性的平均住院时间较长，但在手术再探查和手术时间方面没有差异。AA和W妇女的30天死亡率无差异（3% vs 2%，P - 0.45）。非裔美国人更年轻，更可能肥胖，患有糖尿病，高血压，术前体重减轻，血清肌酐水平高于或等于2 mg/dL，低白蛋白血症和贫血。在调整手术复杂性和相关合并症后，AA种族不是术后30天并发症的独立预测因素（比值比，0.99; 95%置信区间[CI]，0.65-1.5; P = 0.96）或死亡率（优势比，0.89; 95%可信区间，0.25-2.43; P = 0.83）。结论：非裔美国人种族不是30天不良结局的独立预测因子。有趣的是，患有OC的AA在追求质量的医院中代表性不足。尽量减少这种种族差异的努力应该针对合并症的优化和改善AA妇女进入高容量中心的机会。
Background: The improved survival observed in recent years for women with ovarian cancer (OC) has not been realized among African American (AA) compared with white (W) women. The contribution of immediate postoperative morbidity and mortality to this survival disparity remains unclear. This study aims to examine disparities in postoperative 30-day morbidity and mortality between AA and W women with OC.Materials and Methods: Patients with OC were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2005 to 2011. African American and subgroups were studied. Multivariable logistic regression models were performed.Results: Of 1649 women, 1510 (92%) were Wand 139 (8%) were AA. The rate of 30-day postoperative complications and mortality among the entire cohort were 30% and 2%, respectively. No differences in postoperative complications were noted between AA and W women (33% vs 30%, P = 0.47) including surgical (29% vs 26%, P = 0.40) and nonsurgical (10% vs 9%, P = 0.75) complications. The mean length of hospital stay was longer in AA women, but there was no difference in surgical re-exploration and operative time. No difference in 30-day mortality was found between AA and W women (3% vs 2%, P - 0.45). African Americans were younger and more likely to be obese, have diabetes, hypertension, preoperative weight loss, higher serum creatinine level greater than or equal to 2 mg/dL, hypoalbuminemia, and anemia. After adjusting for surgical complexity and associated comorbidities, AA race was not an independent predictor of 30-day postoperative complications (odds ratio, 0.99; 95% confidence interval [CI], 0.65-1.5; P = 0.96) or mortality (odds ratio, 0.89; 95% confidence interval, 0.25-2.43; P = 0.83).Conclusions: African American race was not an independent predictor of poor 30-day outcomes. Interestingly, AAs with OC are underrepresented in quality-seeking hospitals. Efforts to minimize this racial disparity should target optimization of comorbidities and improving access to high-volume centers for AA women.