{"title":"县级粮食不安全与心脏手术后的结果有关","authors":"","doi":"10.1016/j.amjsurg.2024.115907","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery.</p></div><div><h3>Methods</h3><p>In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of “optimal” post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival.</p></div><div><h3>Results</h3><p>Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 % CI: 0.90–0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 % CI: 1.12–1.36) and extended LOS (OR: 1.07, 95 % CI: 1.01–1.14) (all p < 0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 % CI: 1.06–1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 % CI: 1.17–1.38, p < 0.0001) compared with White patients within the same FI level.</p></div><div><h3>Conclusions</h3><p>County-level FI was associated with worse outcomes following cardiac surgery.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"County-level food insecurity is associated with outcomes following cardiac surgery\",\"authors\":\"\",\"doi\":\"10.1016/j.amjsurg.2024.115907\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery.</p></div><div><h3>Methods</h3><p>In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of “optimal” post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival.</p></div><div><h3>Results</h3><p>Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 % CI: 0.90–0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 % CI: 1.12–1.36) and extended LOS (OR: 1.07, 95 % CI: 1.01–1.14) (all p < 0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 % CI: 1.06–1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 % CI: 1.17–1.38, p < 0.0001) compared with White patients within the same FI level.</p></div><div><h3>Conclusions</h3><p>County-level FI was associated with worse outcomes following cardiac surgery.</p></div>\",\"PeriodicalId\":7771,\"journal\":{\"name\":\"American journal of surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-08-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002961024004598\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002961024004598","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景由于评估食物不安全状况(FI)和手术结果的文献有限,我们试图评估县级 FI 与心脏手术后结果之间的关联。方法在一项回顾性队列中,利用医疗保险标准分析档案确定了 2016 年至 2020 年期间接受冠状动脉旁路移植术的患者。利用县级 FI 将患者分为低、中、高三个组群。主要结果是教科书结果,这是衡量 "最佳 "术后结果的指标。结果在267,914名患者中,居住在高FI地区的患者不太可能获得教科书结果(OR:0.94,95 % CI:0.90-0.99)。在评估各相关术后结果时,FI 偏高地区患者的 90 天死亡率(OR:1.24,95 % CI:1.12-1.36)和 LOS 延长率(OR:1.07,95 % CI:1.01-1.14)也更高(均为 P < 0.0001)。此外,与粮食不安全程度低的地区相比,这些人群的 5 年死亡率风险更高(HR:1.11,95 % CI:1.06-1.17)。在粮食不安全程度较高的县,种族差异依然存在,因为与粮食不安全程度相同的白人患者相比,黑人患者的 5 年死亡风险更高(HR:1.27,95 % CI:1.17-1.38,p < 0.0001)。
County-level food insecurity is associated with outcomes following cardiac surgery
Background
As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery.
Methods
In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of “optimal” post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival.
Results
Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 % CI: 0.90–0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 % CI: 1.12–1.36) and extended LOS (OR: 1.07, 95 % CI: 1.01–1.14) (all p < 0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 % CI: 1.06–1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 % CI: 1.17–1.38, p < 0.0001) compared with White patients within the same FI level.
Conclusions
County-level FI was associated with worse outcomes following cardiac surgery.
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.