American journal of surgery · 2024
Caprini guideline indicated venous thromboembolism (VTE) prophylaxis among inpatient surgical patients: are there racial/ethnic differences in practice patterns and outcomes?
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Edwards Michael A, Falstin Mark, Uddandam Akash, Brennan Emily, Spaulding Aaron
Аннотация
BACKGROUND: While racial disparity in surgical mortality due to venous thromboembolism (VTE) has improved, a gap persists. Our study aim was to determine differences in VTE prevention practices and their impact on outcomes among racial surgical cohorts.
METHODS: Elective surgeries performed between 1.1.2016 and 5.31.2021 were included. Racial/ethnic cohorts were propensity-matched 1:1 to non-Hispanic White (NHW) patients, and outcomes were compared using unadjusted logistic regression. Match cohort balance was assessed using absolute standardized mean differences and linear model analysis of variance (ANOVA). Pearson's Chi-square tests evaluated bi-variate associations. Conditional logistic regression to compare outcomes between matched groups. Odds ratios, 95 % confidence intervals, and p-values are reported. Analyses were performed using R version 4.1.2 and the R package Matchit.
RESULTS: Non-Hispanic other race (NHOR) (vs. NHW) patients were less likely to receive inpatient prophylaxis (OR 0.86, CI:0.76-0.98). Appropriate prophylaxis resulted in similar VTE for NHB (p = 0.71) and Hispanic (p = 0.06), compared to NHW patients. Inpatient bleeding was higher in Hispanic patients with a higher likelihood of receiving appropriate prophylaxis (OR 1.94, CI:1.16-3.32) and NHOR patients with a lower likelihood (OR 1.90, CI:1.10-3.36) CONCLUSION: Postoperative VTE was similar for minority patients receiving appropriate prophylaxis, compared to NHW patients. Inpatient bleeding was more likely in Hispanic and NHOR patients but may not be related to receiving appropriate prophylaxis. NHOR patients were less likely to receive inpatient thromboprophylaxis.
METHODS: Elective surgeries performed between 1.1.2016 and 5.31.2021 were included. Racial/ethnic cohorts were propensity-matched 1:1 to non-Hispanic White (NHW) patients, and outcomes were compared using unadjusted logistic regression. Match cohort balance was assessed using absolute standardized mean differences and linear model analysis of variance (ANOVA). Pearson's Chi-square tests evaluated bi-variate associations. Conditional logistic regression to compare outcomes between matched groups. Odds ratios, 95 % confidence intervals, and p-values are reported. Analyses were performed using R version 4.1.2 and the R package Matchit.
RESULTS: Non-Hispanic other race (NHOR) (vs. NHW) patients were less likely to receive inpatient prophylaxis (OR 0.86, CI:0.76-0.98). Appropriate prophylaxis resulted in similar VTE for NHB (p = 0.71) and Hispanic (p = 0.06), compared to NHW patients. Inpatient bleeding was higher in Hispanic patients with a higher likelihood of receiving appropriate prophylaxis (OR 1.94, CI:1.16-3.32) and NHOR patients with a lower likelihood (OR 1.90, CI:1.10-3.36) CONCLUSION: Postoperative VTE was similar for minority patients receiving appropriate prophylaxis, compared to NHW patients. Inpatient bleeding was more likely in Hispanic and NHOR patients but may not be related to receiving appropriate prophylaxis. NHOR patients were less likely to receive inpatient thromboprophylaxis.