Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer.
Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer.
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减少亚裔美国人结直肠癌的差异并改善手术结果。
DOI：
10.1016/j.jss.2017.05.036
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
D. Chu
中科院分区：
文献类型：
--
作者：
Kayln C Mulhern;Tyler S. Wahl;Lauren E. Goss;Katey Feng;J. Richman;M. Morris;Herbert Chen;D. Chu
研究表明，与其他种族相比，亚裔美国人可能有更好的肿瘤预后。我们假设，与其他种族/民族相比，亚裔结直肠癌患者在死亡率、术后并发症（POCs）、住院时间（LOS）和再入院率方面的手术结果会有所改善。方法我们查询2011-2014年美国外科医师学会国家手术质量改进计划中接受结直肠癌手术的患者，并按种族分层。主要结局是30天死亡率，次要结局包括POCs、LOS和30天再入院。采用逐步后向逻辑回归分析和事故率比计算来确定不同结果的危险因素。结果在28283例因恶性结直肠手术的患者中，种族/民族分为高加索美国人（84%）、非洲裔美国人（12%）和亚裔美国人（4%）。在未经调整的分析中，与其他种族/民族相比，亚裔美国人更有可能拥有正常体重，不吸烟，并且美国麻醉医师学会评分较低，为1或2分（P< 0.001）。术后，亚裔美国人的LOS最短，肠梗阻、呼吸和肾脏并发症发生率最低（P< 0.001）。30天死亡率和再入院率没有种族差异。在调整分析中，亚裔美国人的种族与较少的术后肠梗阻独立相关（优势比0.8,95%可信区间0.66-0.98，P< 0.001），与非裔美国人和白种人美国患者相比，LOS分别降低13%和4% （P< 0.001）。结论与其他种族/民族相比，亚裔美国人接受结直肠癌手术的LOS较短，POCs较少，30天死亡率和再入院率无差异。这些差异背后的机制需要进一步研究，但可能是患者、提供者和医疗保健系统差异的结果。
BackgroundStudies suggest Asian Americans may have improved oncologic outcomes compared with other ethnicities. We hypothesized that Asian Americans with colorectal cancer would have improved surgical outcomes in mortality, postoperative complications (POCs), length of stay (LOS), and readmissions compared with other racial/ethnic groups.MethodsWe queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program for patients who underwent surgery for colorectal cancer and stratified patients by race. Primary outcome was 30-d mortality with secondary outcomes including POCs, LOS, and 30-d readmission. Stepwise backward logistic regression analyses and incident rate ratio calculations were performed to identify risk factors for disparate outcomes.ResultsOf the 28,283 patients undergoing colorectal surgery for malignancy, racial/ethnic groups were divided into Caucasian American (84%), African American (12%), or Asian American (4%). On unadjusted analyses, compared with other racial/ethnic groups, Asian Americans were more likely to have normal weight, not smoke, and had lower American Society of Anesthesiologists score of 1 or 2 (P< 0.001). Postoperatively, Asian Americans had the shortest LOS and the lowest rates of complications due to ileus, respiratory, and renal complications (P< 0.001). There were no racial differences in 30-d mortality or readmission. On adjusted analyses, Asian American race was independently associated with less postoperative ileus (odds ratio 0.8, 95% confidence interval 0.66-0.98,P< 0.001) and decreased LOS by 13% and 4% compared with African American and Caucasian American patients, respectively (P< 0.001).ConclusionsAsian Americans undergoing surgery for colorectal cancer have shorter LOS and fewer POCs when compared with other racial/ethnic groups without differences in 30-d mortality or readmissions. The mechanism(s) underlying these disparities will require further study, but may be a result of patient, provider, and healthcare system differences.