头颈部肿瘤手术后合并症和治疗效果的种族差异

Usama Waqar, A. Arif, A. Hameed, S. M. A. Zaidi, Muhammad Hamza, H. Iftikhar, Huma Naz, S. A. Abbas
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摘要

尽管人们试图建立一个平等的手术护理框架,但种族差异依然存在。这项回顾性研究纳入了2008年至2020年间接受头颈部肿瘤手术的成年患者,这些患者来自国家外科手术质量改进计划(National Surgical Quality Improvement Program)。研究人员进行了多变量回归分析,以探讨以下种族类别与术后结果的关系:研究共纳入了 113,234 名患者,其中白人占 78.3%,黑人占 8.7%,西班牙裔占 6.9%,亚裔占 6.0%。与白人患者相比,黑人患者的原有合并症发生率更高。具体来说,黑人患者中糖尿病(19.8% 对 12.4%)、高血压(57.5% 对 41.5%)、吸烟史(18.8% 对 15.0%)、呼吸困难(7.4% 对 5.7%)和术前贫血(43.6% 对 36.5%)等合并症的发病率更高。在回归分析中,与白人患者相比,黑人种族与头颈部肿瘤手术后的主要发病率无关(几率比为 1.098,95% 置信区间为 0.935-1.289)。然而,与黑人种族相关的合并症与主要发病风险增加之间存在明显关联。接受头颈部肿瘤手术的黑人患者因合并症较多而面临巨大挑战,而这些合并症又被发现与术后主要发病率有关。
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Racioethnic disparities in comorbidities and outcomes following head and neck oncologic surgery
Racial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors.This retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian.A total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity.Black patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.
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