美国食管切除术患者的差异和获得胸外科医生的机会。

Christine E Alvarado, Stephanie G Worrell, Anuja L Sarode, Aria Bassiri, Boxiang Jiang, Philip A Linden, Christopher W Towe
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引用次数: 0

摘要

食管切除术是一项复杂的手术,发病率和死亡率都很高。先前的研究表明,亚专业化与食管切除术结果的改善有关。我们假设,根据人口统计、地理和医院因素,食管切除术患者在接受胸外科医生治疗方面存在差异。Premier医疗保健数据库用于识别2015年至2019年使用ICD-10代码接受食管和贲门癌症、巴雷特食管和贲门失弛缓症食管切除术的成年住院患者。患者被分类为从胸腔和非胸腔提供者那里接受食管切除术。调查方法用于校正抽样误差。在调查加权多变量逻辑回归中,使用双变量分析的反向选择来确定食管切除术提供者专业化的预测因素。在研究期间,960名患者符合入选标准,估计人群规模为3894名患者。其中,1696例(43.5%)由胸部外科医生进行,2199例(56.5%)由非胸部提供者进行。在多变量分析中,与接受胸部护理的可能性降低相关的因素包括黑人(OR 0.41,p
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Disparities and access to thoracic surgeons among esophagectomy patients in the United States.

Esophagectomy is a complex operation with significant morbidity and mortality. Previous studies have shown that sub-specialization is associated with improved esophagectomy outcomes. We hypothesized that disparities would exist among esophagectomy patients regarding access to thoracic surgeons based on demographic, geographic, and hospital factors. The Premier Healthcare Database was used to identify adult inpatients receiving esophagectomy for esophageal and gastric cardia cancer, Barrett's esophagus, and achalasia from 2015 to 2019 using ICD-10 codes. Patients were categorized as receiving their esophagectomy from a thoracic versus non-thoracic provider. Survey methodology was used to correct for sampling error. Backwards selection from bivariable analysis was used in a survey-weighted multivariable logistic regression to determine predictors of esophagectomy provider specialization. During the study period, 960 patients met inclusion criteria representing an estimated population size of 3894 patients. Among them, 1696 (43.5%) were performed by a thoracic surgeon and 2199 (56.5%) were performed by non-thoracic providers. On multivariable analysis, factors associated with decreased likelihood of receiving care from a thoracic provider included Black (OR 0.41, p < 0.001), Other (OR 0.21, p < 0.001), and Unknown race (OR 0.22, p = 0.04), and uninsured patients (OR 0.53, p = 0.03). Urban hospital setting was associated with an increased likelihood of care by a thoracic provider (OR 4.43, p = 0.001). In this nationally representative study, Nonwhite race, rural hospital setting, and lower socioeconomic status were factors associated with decreased likelihood of esophagectomy patients receiving care from a thoracic surgeon. Efforts to address these disparities and provide appropriate access to thoracic surgeons is warranted.

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