Impact of Race on the Surgical Management of Adhesive Small Bowel Obstruction

被引:9
作者
Chiu, Alexander S. [1 ]
Jean, Raymond A. [1 ,2 ]
Davis, Kimberly A. [3 ]
Pei, Kevin Y. [3 ]
机构
[1] Yale Sch Med, Dept Surg, New Haven, CT USA
[2] Yale Sch Med, Dept Internal Med, Natl Clinician Scholars Program, New Haven, CT USA
[3] Yale Sch Med, Dept Surg, Sect Gen Surg Trauma & Surg Crit Care, 330 Cedar St,BB310, New Haven, CT 06519 USA
基金
美国国家卫生研究院;
关键词
RACIAL DISPARITIES; UNITED-STATES; UNCONSCIOUS RACE; CLASS BIAS; OUTCOMES; SURGERY; CARE; MORTALITY; QUALITY; CANCER;
D O I
10.1016/j.jamcollsurg.2017.11.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Small bowel obstruction (SBO) represents roughly 15% of admissions by general surgeons. Management of SBO relies heavily on provider judgment, including decisions on how long to try nonsurgical management and whether to use a laparoscopic or open approach when surgery is needed. Given the subjective nature of these decisions, it is unknown if patient race influences management of SBO. STUDY DESIGN: The National Surgical Quality Improvement Program was used to identify patients who underwent adhesiolysis or small bowel resection for adhesive SBO between 2010 and 2015 (n = 13,896). Adjusted logistic regression models incorporating patient comorbidity, American Society of Anesthesiologists (ASA) class, and emergency status were used to analyze odds of receiving surgery after 5 days from hospital admission (Eastern Association for the Surgery of Trauma guidelines) and of undergoing an open operation. RESULTS: Patients who waited more than 5 days for a procedure had greater adjusted odds of postoperative complication (odds ratio [OR] 1.56 95% CI 1.37 to 1.79) compared with those waiting 5 days or less. Similarly, open procedures had higher odds of complication compared with laparoscopic (OR 2.31 95% CI 2.00 to 2.68). Regression analysis demonstrated that black patients were significantly more likely than white patients to wait more than 5 days for surgery (OR 1.31 95% CI [1.13-1.53]) and undergo open surgery (OR 1.56, 95% CI 1.36 to 1.79). There was no statistical difference for Hispanics patients waiting more than 5 days (OR 0.98, 95% CI 0.73 to 1.31) or receiving open surgery (OR 0.84, 95% CI 0.70 to 1.01) compared with white patients. CONCLUSIONS: Clinical decisions regarding SBO management differ based on patient race. Future studies focusing on the surgical decision-making process and the influence of bias are needed. Published by Elsevier Inc. on behalf of the American College of Surgeons.
引用
收藏
页码:968 / 976
页数:9
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