Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
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年龄和种族差异接受微创腹股沟疝修补术的机制。
DOI：
10.1007/s00464-019-06695-0
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Telem,DanaA
中科院分区：
文献类型：
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作者：
Vu,JocelineV;Gunaseelan,Vidhya;Dimick,JustinB;Englesbe,MichaelJ;CampbellJr,DarrellA;Telem,DanaA
背景黑人患者和老年人不太可能接受微创疝修补术。种族和年龄的这些差异可能受到微创修复术的外科医生特定使用率的影响。在这项研究中，我们探讨了种族，年龄和外科医生利用微创手术（MIS）与接受MIS腹股沟疝repair.MethodsA回顾性队列研究的可能性之间的关联进行择期原发性腹股沟疝修补术的患者从2012年至2016年，使用密歇根州外科质量协作，72医院的临床注册表的数据。外科医生按施行MIS的比例进行分层。使用分层Logistic回归模型，我们调查了接受MIS修复和种族，年龄和外科医生MIS utilizationrate.ResultsOut的4667例患者，1253（27%）接受MIS修复之间的关联。在190名外科医生中，81名（43%）仅进行了开放修复。控制外科医生MIS使用率，种族与MIS接受率无关（OR 0.93，p = 0.775），但老年患者接受MIS修复的可能性较低（OR 0.41，p < 0.001）。相反，即使在调整合并症后，年龄差异与MIS使用无关，表明提供者对老年患者进行MIS修复存在一定程度的偏见。解决差距的干预措施应包括系统地努力改善获得服务的机会，以及对老年人的提供者和患者教育。
BackgroundBlack patients and older adults are less likely to receive minimally invasive hernia repair. These differences by race and age may be influenced by surgeon-specific utilization rate of minimally invasive repair. In this study, we explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair.MethodsA retrospective cohort study was performed in patients undergoing elective primary inguinal hernia repair from 2012 to 2016, using data from the Michigan Surgical Quality Collaborative, a 72-hospital clinical registry. Surgeons were stratified by proportion of MIS performed. Using hierarchical logistic regression models, we investigated the association between receiving MIS repair and race, age, and surgeon MIS utilization rate.ResultsOut of 4667 patients, 1253 (27%) received MIS repair. Out of 190 surgeons, 81 (43%) performed only open repair. Controlling for surgeon MIS utilization, race was not associated with MIS receipt (OR 0.93,p= 0.775), but older patients were less likely to receive MIS repair (OR 0.41,p< 0.001).ConclusionsRace differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients. Interventions to address disparities should include systematic efforts to improve access, as well as provider and patient education for older adults.