美国胸腺切除术治疗肌无力的使用趋势和差异。

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2024-10-01 Epub Date: 2024-06-12 DOI:10.1212/CPJ.0000000000200335
Jennifer Morganroth, Leah Zuroff, Amanda C Guidon, Grant T Liu, Shawn J Bird, Sunil Singhal, Gil I Wolfe, Ali G Hamedani
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引用次数: 0

摘要

背景和目的:2016年,一项随机对照试验证明了经胸骨胸腺切除术对非胸腺瘤性肌无力(MG)患者的临床疗效。该试验后,临床实践是否发生了大规模的变化尚不得而知:我们利用 2012 年至 2019 年的全国住院患者样本(NIS)数据进行了一项回顾性纵向横断面分析。我们的研究纳入了至少 18 岁、被诊断为 MG 且未伴有胸腺瘤的住院成人。我们使用连接点回归分析了 2012 年至 2019 年胸腺切除术量和手术方式(微创与经胸腔)的年度趋势。利用逻辑回归模型,我们研究了可能影响是否进行胸腺切除术的患者和医院层面的因素,如年龄、性别、种族、保险支付方、医院规模和教学状况以及埃利克豪斯综合指数。考虑到 NIS 复杂的调查设计,采用了抽样权重:2012年至2019年期间,胸腺切除术的总数每年增加69.8%(95% CI 40.1-105.8)。经胸骨胸腺切除术每年增加 62.8%(95% CI 35.8-95.2),微创胸腺切除术每年增加 83.7%(95% CI 38.1-144.3)。与 2012-2016 年相比,2017-2019 年胸腺切除术的发生率明显更高(OR 1.93,95% CI 1.62-2.31)。在多变量回归模型中,有几个因素降低了MG患者进行胸腺切除术的几率:年龄较大、黑人种族(OR 0.62,95% CI 0.49-0.77)、女性(OR 0.73,95% CI 0.63-0.86)和Elixhauser综合指数较高。中型(OR 1.82,95% CI 1.30-2.55)或大型(OR 2.81,95% CI 2.07-3.82)医院和城市教学医院(OR 6.09,95% CI 2.65-13.97)的患者更有可能接受胸腺切除术:胸腺切除术越来越多地用于非胸腺肿瘤性MG,尤其是在2016年一项积极的III期临床试验公布后。在胸腺切除术的使用方面存在一些差异,值得进一步关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trends and Disparities in the Utilization of Thymectomy for Myasthenia Gravis in the United States.

Background and objectives: In 2016, a randomized controlled trial demonstrated the clinical efficacy of trans-sternal thymectomy for patients with non-thymomatous myasthenia gravis (MG). Whether large-scale changes occurred in clinical practice after this trial is unknown.

Methods: We performed a retrospective longitudinal cross-sectional analysis using National Inpatient Sample (NIS) data from 2012 to 2019. Our study included hospitalized adults at least 18 years of age diagnosed with MG without an associated thymoma. We used joinpoint regression to analyze annual trends in thymectomy volume and surgical approach (minimally invasive vs trans-sternal) from 2012 to 2019. Using logistic regression models, we examined patient and hospital-level factors that may have influenced whether thymectomy was performed, such as age, sex, race, insurance payor, hospital size and teaching status, and Elixhauser Comorbidity Index. Sampling weights were applied to account for the complex survey design of NIS.

Results: The total number of thymectomy procedures increased by 69.8% per year (95% CI 40.1-105.8) between 2012 and 2019. Trans-sternal thymectomies increased by 62.8% per year (95% CI 35.8-95.2) and minimally invasive thymectomies by 83.7% per year (95% CI 38.1-144.3). Thymectomies were significantly more likely to occur in 2017-2019 compared with 2012-2016 (OR 1.93, 95% CI 1.62-2.31). In a multivariable regression model, several factors decreased the odds of patients with MG having a thymectomy: older age, Black race (OR 0.62, 95% CI 0.49-0.77), female (OR 0.73, 95% CI 0.63-0.86), and higher Elixhauser Comorbidity Index. Patients in medium (OR 1.82, 95% CI 1.30-2.55) or large (OR 2.81, 95% CI 2.07-3.82) size and urban teaching hospitals (OR 6.09, 95% CI 2.65-13.97) were more likely to undergo thymectomy.

Discussion: Thymectomy is being performed more frequently for non-thymomatous MG, especially after 2016 after publication of a positive phase III clinical trial. There are several disparities in thymectomy utilization that warrant further attention.

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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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