Impact of hospital volume on racial disparities in cardiovascular procedure mortality.
Impact of hospital volume on racial disparities in cardiovascular procedure mortality.
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医院容量对心血管手术死亡率种族差异的影响。
DOI：
10.1016/j.jacc.2005.08.068
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发表时间：
2006
影响因子：
24
通讯作者：
Ayanian,JohnZ
中科院分区：
文献类型：
--
作者：
Trivedi,AmalN;Sequist,ThomasD;Ayanian,JohnZ
目的我们根据种族和民族对低容量医院在主要心血管手术中的使用进行评估，并确定医院容量是否是解释术后死亡率种族和民族差异的重要因素。背景低医院容量预测心血管手术死亡率，并可能是手术结果的种族和民族差异的中介因素。方法我们使用全国住院样本分析了1998-2001年间719,679例因心脏动脉旁路移植(CABG)、经皮冠状动脉腔内成形术(PTCA)、腹主动脉瘤(AAA)修补术和颈动脉内膜切除术(CEA)住院的数据。我们使用多元Logistic回归来评估种族是否预测低容量医院的使用，以及医院容量对术后住院死亡率种族差异的相对贡献。结果黑人和西班牙裔患者比白人患者更有可能在低容量医院接受心血管手术。黑人患者的风险调整死亡率高于白人患者(优势比[OR]，1.84；95%可信区间[CI]，1.20至2.84)、冠状动脉旁路移植术(OR，1.19；95%CI，1.06至1.33)和CEA(OR，1.56；95%CI，1.07至2.27)，但不包括PTCA。西班牙裔患者的风险调整死亡率并不高于白人患者。与白人患者相比，调整医院容量并不能显著降低黑人患者死亡的相对风险。结论黑人和西班牙裔患者更有可能在低流量医院接受心血管手术，但医院容量不能解释术后死亡率的种族差异。还需要进一步的研究来确定为什么黑人患者在心血管手术后死亡率增加，以及如何降低这些死亡率。
ObjectivesWe assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality.BackgroundLow hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes.MethodsWe analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA) from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality.ResultsBlack and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.20 to 2.84), CABG (OR, 1.19; 95% CI, 1.06 to 1.33), and CEA (OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients.ConclusionsBlack and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.