在广泛的手术患者群体中,社会脆弱性与更高的经风险调整后术并发症率有关
Adam R Dyas1, Heather Carmichael2, Michael R Bronsert3
1Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
American journal of surgery
|September 29, 2023
概括
手术患者的高社会脆弱性指数 (SVI) 与增加的并发症和不良结果有关. 需要针对这一高风险人群进行有针对性的干预,以改善手术护理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 外科手术的结果
- 健康差异 在健康上的差异
背景情况:
- 健康的社会决定因素显著影响手术患者的结果.
- 社会脆弱性指数 (SVI) 基于社会人口统计学因素量化了社区层面的风险.
研究的目的:
- 调查社会脆弱性指数 (SVI) 与风险调整后术并发症之间的关联.
- 为了确定SVI是否在多样化的手术患者群体中预测不良结果.
主要方法:
- 在五家医院 (2012-2017) 的31,224名手术患者进行了回顾性队列研究.
- 患者地址被地理编码以估计SVI,将患者分为低 (得分<75) 和高 (得分≥75) SVI组.
- 多变量后勤回归分析了使用ACS-NSQIP数据对高SVI队列的并发症风险调整概率.
主要成果:
- 患有高SVI的患者更有可能属于种族少数群体,具有并发症,较高的ASA类,功能依赖,并接受紧急手术.
- 高SVI显着与更高的30天死亡率,整体发病率,特定并发症 (呼吸道,心脏,传染病) 和未计划的再入院相关.
- 经过风险调整后,高SVI与死亡率/计划外再接收之间的关联不再显著,但其他不良结果仍然存在.
结论:
- 增加的SVI与许多不良的外科手术结果相关,即使经过对临床因素进行调整.
- 这凸显了社会决定因素在手术患者风险分层中的重要性.
- 为高SVI人群制定有针对性的预防策略对于减轻手术风险和改善护理至关重要.
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