黑人患者在动脉置换中经历了更高的并发症负担和不同的门选择模式
Joshua D Greendyk1, Julia DeLorenzo1, Jonathan R Lopez1
1Department of Medicine, Division of Cardiology, Rutgers University New Jersey Medical School, Newark, USA.
Cureus
|March 3, 2026
概括
黑人患者在主动脉置换 (AVR) 获得和结果方面面临差异. 虽然年轻的黑人患者使用罗斯手术的比例更高,但所有黑人患者经历了更严重的术后并发症,这表明系统性不平等.
科学领域:
- 心血管外科心血管外科
- 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:
- 与传统的机械和生物假体相比,罗斯手术对大动脉置换 (AVR) 可能为年轻人提供更好的结果.
- 对于获得罗斯手术的种族差异以及随后的术后结果还不太清楚.
- 假设:黑人患者因有限的门选择而有不同的罗斯手术利用率,并发症的持续差异.
研究的目的:
- 为了评估在获得罗斯手术以进行大动脉置换方面的种族差异.
- 评估AVR术后后果的种族差异,特别是比较黑人和白人患者.
- 确定黑人种族是否是AVR后手术后并发症的独立预测因素.
主要方法:
- 从美国外科医生学院国家外科质量改进计划 (ACS-NSQIP) 数据库 (2012-2021) 分析开放的AVR病例 (不包括过导管AVR).
- 具有机构审查委员会 (IRB) 豁免的非识别数据.
- 单变量分析和倾向得分与二进制后勤回归相匹配,以评估黑人种族对准入和30天并发症的影响,控制年龄,BMI和并发症等共变量.
主要成果:
- 在5,698例AVR病例中,罗斯手术很少发生 (4.6%). 白人患者占病例的93.7%.
- 年轻的黑人患者 (<60岁) 比白人患者更容易接受罗斯手术,尽管黑人患者总体上接受的机械AVR较少.
- 黑人患者在所有门类型中经历了更高的术后并发症 (急性功能衰竭,长时间通风,再输管,心脏骤停,30天死亡率). 经过调整后的分析证实,黑人种族是严重并发症的独立预测因素.
结论:
- 黑人和白人的AVR利用和结果差异源于结构,社会经济和临床因素,而不是生物学差异.
- 在年轻的黑人患者中,罗斯手术的使用增加可能反映了有限的门选择和更高的并发症负担.
- 黑人患者持续出现更差的结果强调了基线风险和系统不平等的影响,需要研究社会经济和护理提供因素,以及为标准化护理和公平提供临床干预措施.
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