Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022
Evaluation of Racial/Ethnic Disparities in the Surgical Management of Inflammatory Bowel Disease.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ore Ana Sofia, Vigna Carolina, Fabrizio Anne, Messaris Evangelos
Аннотация
BACKGROUND: Disparities in managing inflammatory bowel disease (IBD) are multifactorial and occur at all stages of treatment, including surgical management. We aim to evaluate postoperative morbidity after abdominopelvic surgery among different racial/ethnic groups after surgical management of CD and UC and account for preoperative characteristics that may impact outcomes.
METHODS: Patients were identified using the National Surgical Quality Improvement Project (NSQIP) file and merged with the targeted proctectomy (2016-2019) and colectomy file (2012-2019). All patients undergoing elective surgical management for ICD9/10 codes for CD and UC were included. The primary outcome was composite postoperative morbidity (CPM), a metric that identifies postoperative morbidity with available variables. Multivariable logistic regression modeling was performed to test the association between race/ethnicity and other risk factors with CPM. Postoperative outcomes were evaluated using propensity score modeling with 1:1 matching without replacement as a secondary analysis.
RESULTS: In both CD and UC, CPM was highest for Black patients with 27.5% (326) and 26.1% (81), respectively. Followed by Hispanic patients with a CPM of 21.1% (73) after surgery for CD (p < 0.001) and 21.2% (31) for Asian patients after resection for UC (p = 0.005). After regression modeling, we found increased odds of CPM for Black patients after surgery for UC (OR 1.48, p = 0.013) and CD (OR 1.17, p < 0.001). Following propensity score matching (PSM), stoma creation rates were higher in Asian (10.4%, p = 0.010) and Hispanic patients (11.9%, p = 0.030) undergoing surgery for CD.
CONCLUSIONS: Black patients are at increased risk of morbidity after surgery for both UC and CD. Increased morbidity in an already vulnerable population warrants targeted interventions, specifically focusing on faster access to specialized care, preoperative optimization, and culturally competent discussions on the benefits of MIS approaches are warranted in order to improve postoperative outcomes.
METHODS: Patients were identified using the National Surgical Quality Improvement Project (NSQIP) file and merged with the targeted proctectomy (2016-2019) and colectomy file (2012-2019). All patients undergoing elective surgical management for ICD9/10 codes for CD and UC were included. The primary outcome was composite postoperative morbidity (CPM), a metric that identifies postoperative morbidity with available variables. Multivariable logistic regression modeling was performed to test the association between race/ethnicity and other risk factors with CPM. Postoperative outcomes were evaluated using propensity score modeling with 1:1 matching without replacement as a secondary analysis.
RESULTS: In both CD and UC, CPM was highest for Black patients with 27.5% (326) and 26.1% (81), respectively. Followed by Hispanic patients with a CPM of 21.1% (73) after surgery for CD (p < 0.001) and 21.2% (31) for Asian patients after resection for UC (p = 0.005). After regression modeling, we found increased odds of CPM for Black patients after surgery for UC (OR 1.48, p = 0.013) and CD (OR 1.17, p < 0.001). Following propensity score matching (PSM), stoma creation rates were higher in Asian (10.4%, p = 0.010) and Hispanic patients (11.9%, p = 0.030) undergoing surgery for CD.
CONCLUSIONS: Black patients are at increased risk of morbidity after surgery for both UC and CD. Increased morbidity in an already vulnerable population warrants targeted interventions, specifically focusing on faster access to specialized care, preoperative optimization, and culturally competent discussions on the benefits of MIS approaches are warranted in order to improve postoperative outcomes.