Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome.
Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome.
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DOI：
10.1007/s00246-013-0723-3
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发表时间：
2013
影响因子：
1.6
通讯作者：
Gutgesell, Howard P.
中科院分区：
文献类型：
--
作者：
Dean, Peter N.;McHugh, Kimberly E.;Conaway, Mark R.;Hillman, Diane G.;Gutgesell, Howard P.
关键词：
关于种族、民族和性别对左心发育不全综合征（HLHS）三种姑息治疗结果的影响的信息有限。本研究使用来自大学健康系统联盟的数据，调查了1998年至2007年间，种族、民族、性别、入院类型和手术量对HLHS姑息治疗相关住院死亡率的影响。根据数据，1,949例患者接受了1期姑息治疗（S1P），死亡率为29%，1,279例患者接受了2期姑息治疗（S2P），死亡率为5.4%,1,084例患者接受了3期姑息治疗（S3P），死亡率为4.1%。S1P死亡率增加的危险因素是黑人和“其他”种族、较小的手术量和早期手术时代。S2P死亡率增加的唯一危险因素是黑人种族（11%死亡率；比值比[OR]， 3.19； 95%可信区间[CI] 1.69-6.02）和西班牙裔种族（11%死亡率；比值比[OR]， 3.30; 95% CI, 1.64-6.64）。对于S2P，在手术量排名前五的机构中没有种族差异，但在非前五的机构中存在种族差异。出生后出院的S1P患者的死亡率明显更高（37% vs 24%; p = 0.004），黑人出生后出院的可能性更大（其他种族为12% vs 5%； p < 0.001）。未观察到S3P的种族差异。S1P死亡率增加的危险因素是黑人和“其他”种族、较小的手术体积和早期手术时代。导致S2P住院死亡率增加的危险因素是黑人种族和His-panic种族。
Information is limited regarding the effect of race, ethnicity, and gender on the outcomes of the three palliative procedures for hypoplastic left heart syndrome (HLHS). This study examined the effects of race, ethnicity, gender, type of admission, and surgical volume on in-hospital mortality associated with palliative procedures for HLHS between 1998 and 2007 using data from the University HealthSystem Consortium. According to the data, 1,949 patients underwent stage 1 palliation (S1P) with a mortality rate of 29 %, 1,279 patients underwent stage 2 palliations (S2P) with a mortality rate of 5.4 %, and 1,084 patients underwent stage 3 palliation (S3P) with a mortality rate of 4.1 %. The risk factors for increased mortality with S1P were black and “other” race, smaller surgical volume, and early surgical era. The only risk factors for increased mortality with S2P were black race (11 % mortality; odds ratio [OR], 3.19; 95 % confidence interval [CI] 1.69–6.02) and Hispanic ethnicity (11 % mortality; OR 3.30; 95 % CI 1.64–6.64). For S2P, no racial differences were seen in the top five surgical volume institutions, but racial differences were seen in the non-top-five surgical volume institutions. Mortality with S1P was significantly higher for patients discharged after birth (37 vs 24 %; p = 0.004), and blacks were more likely to be discharged after birth (12 vs 5 % for all other races; p < 0.001). No racial differences with S3P were observed. The risk factors for increased mortality at S1P were black and “other” race, smaller surgical volume, and early surgical era. The risk factors for increased in-hospital mortality with S2P were black race and His-panic ethnicity.
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