Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions.
Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions.
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种族对急诊普通外科手术和非手术结果的条件影响。
DOI：
10.1097/mlr.0000000000001883
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Kelz,RachelR
中科院分区：
文献类型：
--
作者：
Roberts,SanfordE;Rosen,ClaireB;Keele,LukeJ;Kaufman,ElinoreJ;Wirtalla,ChristopherJ;Syvyk,Solomiya;Reilly,PatrickM;Neuman,MarkD;McHugh,MatthewD;Kelz,RachelR
方法：我们确定了全国范围内的黑人和白人医疗保险受益人队列，他们在 2015 年 7 月至 2018 年 6 月期间因常见 EGS 病症住院。使用近远匹配来调整可测量的混杂因素，并使用工具变量分析来控制与治疗分配相关的选择偏倚，我们比较了分层的黑人和白人患者群体中手术和非手术治疗的结果。结果包括院内死亡率、30 天死亡率、非常规出院率和 30 天再入院率。基于 t 检验的交互检验用于确定黑人和白人患者之间手术与非手术治疗的条件效应。 结果：共有 556,087 名患者符合纳入标准，其中 59,519 名（10.7%）为黑人，496,568 名（89.3%）为白人。总体而言，165,932 名患者（29.8%）接受了手术，390,155 名患者（70.2%）接受了非手术治疗。在某些情况下，手术治疗和非手术治疗之间存在显着的结果差异；然而，种族对结果的条件影响没有显着差异。结论：对 EGS 患者进行手术与非手术治疗的决定对手术结果有不同的影响。这些影响因 EGS 条件而异。在因 EGS 疾病住院的全民参保老年人中，种族对手术治疗与非手术治疗的结果没有显着的条件影响。
Methods:We identified a nationwide cohort of Black and White Medicare beneficiaries, hospitalized for common EGS conditions from July 2015 to June 2018. Using near-far matching to adjust for measurable confounding and an instrumental variable analysis to control for selection bias associated with treatment assignment, we compare outcomes of operative and nonoperative management in a stratified population of Black and White patients. Outcomes included in-hospital mortality, 30-day mortality, nonroutine discharge, and 30-day readmissions. An interaction test based on a t test was used to determine the conditional effects of operative versus nonoperative management between Black and White patients.Results:A total of 556,087 patients met inclusion criteria, of which 59,519 (10.7%) were Black and 496,568 (89.3%) were White. Overall, 165,932 (29.8%) patients had an operation and 390,155 (70.2%) were managed nonoperatively. Significant outcome differences were seen between operative and nonoperative management for some conditions; however, no significant differences were seen for the conditional effect of race on outcomes.Conclusions:The decision to manage an EGS patient operatively versus nonoperatively has varying effects on surgical outcomes. These effects vary by EGS condition. There were no significant conditional effects of race on the outcomes of operative versus nonoperative management among universally insured older adults hospitalized with EGS conditions.