BACKGROUND:Previous studies have demonstrated racial and ethnic disparities associated with the outcomes of abdominal aortic aneurysm (AAA) repair, although little is known about the influence of race and ethnicity on the costs associated with these disparities. The current study was undertaken to examine the influence of race and ethnicity on the outcomes of endovascular (EVAR) and open repair (open AAA) of unruptured AAA and its effect on costs in contemporary practice.
METHODS:The Nationwide Inpatient Sample (2005 to 2008) was queried using ICD-9-CM codes for unruptured AAA (441.4). The primary outcomes were mortality and total hospital charges. Multivariate analyses were performed adjusting for age, gender, race, comorbidities (Charlson index), year, insurance type, and hospital characteristics.
RESULTS:A total of 62,728 patients underwent EVAR and 24,253 patients underwent open AAA. White patients (72%) were more likely to undergo EVAR than Hispanic (69%) or black patients (69%; P = 0.02). On univariate analysis, in-hospital mortality after EVAR was increased in Hispanic patients compared with white patients (1% vs 2%; P = 0.02). There were no differences in mortality after EVAR between white and black patients, and there were no racial or ethnic differences in mortality after open AAA. Hispanic ethnicity remained an independent risk factor for increased mortality after AAA repair on multivariate analysis (RR 1.64; 95% CI [1.05 to 2.57]; P = 0.03). Hispanic ethnicity was associated with increased hospital charges compared with white ethnicity after both EVAR ($108,886 vs $77,748; P < 0.001) and open AAA ($134,356 vs $85,536; P < 0.001) and for black patients after open AAA ($101,168 vs $85,536; P = 0.04).
CONCLUSIONS:Hispanic ethnicity is an independent risk factor for mortality after AAA repair independent of insurance type or hospital characteristics. There were dramatic disparities in hospital costs for Hispanic patients undergoing either EVAR or open AAA and for black patients after open AAA compared with white patients. This observation seems unrelated to length of stay, postoperative complications, and admission status. Further studies are needed to determine whether these disparities extend beyond the primary hospitalization.
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【Disparities in outcomes for Hispanic patients undergoing endovascular and open abdominal aortic aneurysm repair.].
【西班牙裔患者接受血管内和开放性腹主动脉瘤修复的预后差异。】
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DOI：10.1016/j.avsg.2012.06.006文章类型：杂志文章
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背景：以前的研究表明，种族和种族差异与腹主动脉瘤（AAA）修复的结果有关，尽管对种族和种族对与这些差异相关的成本的影响知之甚少。当前的研究旨在检验种族和种族对未破裂AAA的血管内（EVAR）和开放式修复（open AAA）的结果及其对现代实践中成本的影响。
方法：使用ICD-9-CM代码对未破裂的AAA（441.4）进行全国住院患者样本（2005年至2008年）的查询。主要结果是死亡率和总住院费用。进行了多元分析，调整了年龄，性别，种族，合并症（查尔森指数），年限，保险类型和医院特征。
结果：共有62728例患者接受了EVAR，24253例患者接受了开放AAA。白人患者（72％）比西班牙裔患者（69％）或黑人患者（69％； P = 0.02）更有可能接受EVAR。单因素分析显示，西班牙裔患者与白人患者相比，EVAR后住院死亡率增加（1％比2％； P = 0.02）。白人和黑人患者的EVAR术后死亡率无差异，开放AAA后死亡率无种族或种族差异。西班牙裔种族仍然是多因素分析AAA修复后死亡率增加的独立危险因素（RR 1.64； 95％CI [1.05至2.57]； P = 0.03）。在EVAR（$ 108,886 vs $ 77,748; P <0.001）和AAA开放性手术后（134,356 vs $ 85,536; P <0.001）和AAA开放后黑人患者（$ 101,168 vs $ 85,536; P = 0.04）。
结论：西班牙裔是AAA修复后死亡率的独立危险因素，与保险类型或医院特征无关。与白人患者相比，接受EVAR或开放性AAA的西班牙裔患者和开放性AAA后的黑人患者的住院费用存在巨大差异。该观察结果似乎与住院时间，术后并发症和入院状态无关。需要进一步研究以确定这些差异是否超出了主要住院治疗的范围。
方法：使用ICD-9-CM代码对未破裂的AAA（441.4）进行全国住院患者样本（2005年至2008年）的查询。主要结果是死亡率和总住院费用。进行了多元分析，调整了年龄，性别，种族，合并症（查尔森指数），年限，保险类型和医院特征。
结果：共有62728例患者接受了EVAR，24253例患者接受了开放AAA。白人患者（72％）比西班牙裔患者（69％）或黑人患者（69％； P = 0.02）更有可能接受EVAR。单因素分析显示，西班牙裔患者与白人患者相比，EVAR后住院死亡率增加（1％比2％； P = 0.02）。白人和黑人患者的EVAR术后死亡率无差异，开放AAA后死亡率无种族或种族差异。西班牙裔种族仍然是多因素分析AAA修复后死亡率增加的独立危险因素（RR 1.64； 95％CI [1.05至2.57]； P = 0.03）。在EVAR（$ 108,886 vs $ 77,748; P <0.001）和AAA开放性手术后（134,356 vs $ 85,536; P <0.001）和AAA开放后黑人患者（$ 101,168 vs $ 85,536; P = 0.04）。
结论：西班牙裔是AAA修复后死亡率的独立危险因素，与保险类型或医院特征无关。与白人患者相比，接受EVAR或开放性AAA的西班牙裔患者和开放性AAA后的黑人患者的住院费用存在巨大差异。该观察结果似乎与住院时间，术后并发症和入院状态无关。需要进一步研究以确定这些差异是否超出了主要住院治疗的范围。
