智力和发育障碍与癌症手术治疗后较差的预后有关。

IF 14.8 2区 医学 Q1 ONCOLOGY
Vivian Resende, Selamawit Woldesenbet, Erryk Katayama, Muhammad Musaab Munir, Henrique Araújo Lima, Mujtaba Khalil, Karol Rawicz-Pruszyński, Muhammad Muntazir Mehdi Khan, Usama Waqar, Parit Mavani, Yutaka Endo, Timothy M Pawlik
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引用次数: 0

摘要

背景:智力和发育障碍(IDD)患者面临着独特的挑战,导致他们在医疗保健方面存在差异。我们试图在一个具有全国代表性的患者群体中确定智力发育障碍对癌症手术后实现 "教科书结果"(TO)的影响:从100%医疗保险标准分析档案数据库中提取了2014年至2020年期间因恶性适应症(包括肺、乳腺、肝脏、胆道、胰腺和结直肠)接受手术的患者数据。使用多变量逻辑回归评估了IDD与TO(定义为无术后并发症、住院时间延长、90天再入院和90天死亡率)、支出和出院状态的关系:在 500,472 位医疗保险受益人中,4,326 位(0.9%)IDD 患者被诊断为癌症(乳腺癌,481 人;肺癌,419 人;肝胆癌,194 人;胰腺癌,145 人;结肠直肠癌,3,087 人)。虽然TO的总发生率为50.5%,但IDD患者获得TO的几率低于非IDD患者(分别为37.1% vs 50.6%;几率比[OR],0.50;95% CI,0.46-0.53;PConclusions:IDD患者术后获得TO以及出院到非家庭环境的几率要低得多。这些数据凸显了改善IDD患者护理的必要性,以确保肿瘤手术护理的公平性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of Intellectual and Developmental Disabilities With Worse Outcomes After Surgical Treatment of Cancer.

Background: Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a "textbook outcome" (TO) following a cancer operation among a nationally representative cohort of patients.

Methods: Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression.

Results: Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46-0.53; P<.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43-1.64), extended length of stay (OR, 2.06; 95% CI, 1.93-2.21), 90-day readmission (OR, 1.15; 95% CI, 1.07-1.24), 90-day mortality (OR, 1.90; 95% CI, 1.70-2.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97-4.62) (all P<.001).

Conclusions: Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.

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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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