Geographic disparities in primary care physicians: Local impact on long-term outcomes in adult liver transplant recipients.

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-10-20 DOI:10.1016/j.amjsurg.2024.116023

Angela L Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z Kiani, Neeta Vachharajani, Franklin C Olumba, Sally Campbell, Adeel S Khan, William C Chapman, Majella B Doyle

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Abstract

Background: Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care.

Methods: Clinical data on adults undergoing liver-only transplant 2010-2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival.

Results: 64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%-8% lower mortality risk (HR_3rd = 0.94, HR_4th = 0.92, HR_5th = 0.94, p for trend = 0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p = 0.002).

Conclusions: Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.

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初级保健医生的地域差异：当地对成人肝移植受者长期疗效的影响。

背景：众所周知，地域不平等会影响肝移植（LT）的获得；然而，这些不平等在术后产生的影响仍不为人知。作为肝移植受者长期护理的经常管理者，我们将重点放在初级保健医生（PCP）身上：方法：我们从器官获取与移植网络（Organ Procurement and Transplantation Network）获取了 2010-2021 年接受纯肝移植手术的成人临床数据，并将其与基于邮政编码的初级保健医生密度和社会脆弱性指数（SVI）数据联系起来，以量化初级保健医生密度对移植物和总体存活率的影响：64,593名患者按PCP密度被分为五等分。与 PCP 密度最低的五分位数患者相比，第三、第四和第五五分位数患者的死亡风险降低了 6%-8%（HR3rd = 0.94，HR4th = 0.92，HR5th = 0.94，趋势 p = 0.002）。在考虑了SVI、当地外科医生和胃肠病医生的可用性后，初级保健医生的密度仍具有显著意义（P = 0.002）：结论：增加初级保健医生的可用性与生存率的提高有关，强调了建立纵向护理的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.

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