结肠癌切除术后的社会脆弱性和术后结果
Erin E Isenberg1, Nicholas Kunnath2, Pasithorn A Suwanabol2
1Department of Surgery, University of Texas at Southwestern, Dallas, TX, United States; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
概括
较高的社会脆弱性与更多的无计划结肠癌手术和较差的患者结果有关,包括一年内较高的死亡率. 解决社会不平等问题对于改善外科手术结果至关重要.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 众所周知,社会脆弱性指数 (SVI) 与较差的外科手术结果有关.
- 对SVI对结肠癌手术结果的具体影响仍未得到充分研究.
研究的目的:
- 调查社会脆弱性指数 (SVI) 与医疗保险患者进行结肠癌切除术的短期 (30天) 和长期 (1年) 术后结果之间的关联.
- 为了确定SVI是否会影响新出现的胆管切除术的可能性.
主要方法:
- 对那些因结肠癌而接受了大肠切除术的医疗保险受益者 (65-99岁) 的回顾性横截面研究 (2016-2020).
- 在人口普查区层面,数据与SVI合并.
- 多变量后勤回归根据患者人口统计和医院特征进行调整,以评估SVI,新出现的切除术和死亡率之间的关联.
主要成果:
- 包括169,498名患者;最高的SVI五分位数与非计划性切除术增加有关 (35.6%对28.9%).
- 在最高SVI五分位数中观察到较高的风险调整后30天死亡率 (3.4%vs2.9%) 和1年死亡率 (10.8%vs8.6%).
- 这些差异在选择性和新兴的外科设置中持续存在.
结论:
- 较高的社会脆弱性增加了医疗保险的结肠癌患者意外切除术和不良术后结果的风险.
- 调查结果强调需要解决结构性社会不平等问题,以减轻手术结果的差异.
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