种族和少数民族患者在不符合临床指导方针的情况下接受手术时增加并发症风险
Adriana P Liimakka1,2, Troy B Amen3, Michael J Weaver1,2
1Harvard Medical School, Boston, Massachusetts.
The Journal of bone and joint surgery. American volume
|March 21, 2024
概括
不符合临床指南的全关节整形术 (TJA) 患者面临更高的并发症风险. 少数群体和那些有公共保险的人不成比例地受到影响,突出显示了手术护理的差异.
科学领域:
- 整形外科手术 整形外科手术
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 采用全关节整形术 (TJA) 的临床指南是不一致的.
- 人们对少数族裔社会人口统计学群体的潜在不平等和劣势存在担忧.
- 这项研究调查了不符合临床指南的患者的TJA结果.
研究的目的:
- 评估未符合临床指南的TJA是否会影响并发症风险.
- 确定偏离指导方针是否会导致术后结果的差异.
- 确定与不符合TJA指导方针相关的人口和保险相关因素.
主要方法:
- 追溯性队列研究11611名初级TJA患者 (2010-2020年).
- 对患者人口统计 (种族,种族) 和保险状况 (医疗保险,医疗补助) 的分析.
- 后勤和混合效应模型用于识别与并发症和准则遵守相关的因素.
主要成果:
- 11%的TJA患者不符合临床指南.
- 不遵循指南的患者中,黑人和西班牙裔的比例更高.
- 不遵守指导方针增加了重新手术的风险,包括感染相关的重新手术.
结论:
- 没有达到手术前标准而接受TJA的患者面临着高的术后并发症风险.
- 这些患者更有可能属于少数群体,具有较低的社会经济地位或公共保险.
- 基于证据的指导方针和共享决策对于减少TJA并发症负担和促进公平至关重要.
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