Racial and Ethnic Disparities in Failure-to-Rescue After Postoperative Sepsis After Noncardiac Surgery.

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia Pub Date : 2025-07-01 Epub Date: 2025-06-16 DOI:10.1213/ANE.0000000000007303

Andres Laserna, Edwin van Wijngaarden, Eric C Sun, Yue Li, Joseph L Nates, Laurent G Glance

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引用次数: 0

Abstract

Background: Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis.

Methods: This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021. Patients were categorized as non-Hispanic White (hereafter, White), non-Hispanic Black (hereafter, Black), Asian, and Hispanic individuals. The association between (1) FTR after sepsis and (2) FTR after septic shock and race and ethnicity was evaluated using multivariable logistic regression. Failure-to-rescue was defined as 30-day mortality among patients who developed postoperative sepsis or postoperative septic shock.

Results: Among the 1388,977 patients (mean [SD] age 60.5 [16]); 783,056 (56.4%) were female, 1017,875 (73%) were White, 171,774 (12%) were Black, 138,457 (10%) were Hispanic, and 60,871 (4%) were Asian. Compared to White individuals, Black (adjusted odds ratio [aOR], 1.29; 95% CI, 1.23-1.35, P < .001) and Hispanic individuals (aOR, 1.15; 95% CI, 1.09-1.21, P < .001) were more likely to develop sepsis; Black individuals were more likely to develop septic shock (aOR, 1.28; 95% CI, 1.21-1.36; P < .001), and Asians were less likely to develop septic shock (aOR 0.84; 95% CI, 0.75-0.93, P = .002). Black individuals experienced lower rates of FTR after sepsis [Black: (aOR, 0.71; 95% CI, 0.54-0.94; P = .017), while Black (aOR, 0.93; 95% CI, 0.80-1.08; P = .35)], Hispanic (aOR, 0.87; 95% CI, 0.72-1.06; P = .16) and Asian Individuals (aOR, 1.06; 95% CI, 0.8-1.37; P = .67) experienced similar rates of FTR after septic shock compared to White individuals.

Conclusions: Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.

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非心脏手术后败血症抢救失败的种族差异。

背景：败血症对边缘社区的影响不成比例。本研究旨在评估种族和民族在败血症术后抢救失败（FTR）方面的差异。方法：本横断面研究使用了美国外科医师学会国家手术质量改进计划中2018年至2021年住院非心脏手术患者的数据。患者分为非西班牙裔白人（以下简称白人）、非西班牙裔黑人（以下简称黑人）、亚洲人和西班牙裔个体。(1)败血症后的FTR和(2)脓毒性休克后的FTR与种族和民族之间的关系使用多变量logistic回归进行评估。抢救失败定义为术后脓毒症或术后脓毒性休克患者的30天死亡率。结果：1388例患者中，977例（平均[SD]年龄60.5 bb0）；女性783,056人（56.4%），白人1017,875人（73%），黑人171,774人（12%），西班牙裔138,457人（10%），亚洲人60,871人（4%）。与白人个体相比，黑人(校正优势比[aOR]， 1.29；95% CI, 1.23-1.35, P < .001)和西班牙裔个体(aOR, 1.15；95% CI, 1.09-1.21, P < 0.001)更容易发生败血症；黑人更容易发生感染性休克(aOR, 1.28；95% ci, 1.21-1.36；P < 0.001)，亚洲人发生感染性休克的可能性较低(aOR 0.84；95% ci, 0.75-0.93, p = 0.002)。黑人败血症后FTR发生率较低[黑人：(aOR, 0.71；95% ci, 0.54-0.94；P = 0.017)，而Black (aOR, 0.93；95% ci, 0.80-1.08；P = 0.35)]，西班牙裔(aOR, 0.87；95% ci, 0.72-1.06；P = 0.16)和亚洲个体(aOR, 1.06；95% ci, 0.8-1.37；P = 0.67)与白人相比，感染性休克后FTR的发生率相似。结论：黑人和西班牙裔患者术后脓毒症发生率较高，但抢救失败率不高。减少手术护理中的不公平应侧重于预防术后败血症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesia and analgesia 医学-麻醉学

CiteScore

9.90

自引率

7.00%

发文量

817

审稿时长

2 months

期刊介绍： Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.