{"title":"亚裔美国人接受完整的肾下腹主动脉瘤血管内修复术后三十天的疗效。","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1016/j.surge.2024.10.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.</p><p><strong>Methods: </strong>Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p < 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.</p><p><strong>Conclusion: </strong>Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thirty-day outcomes of Asian Americans in endovascular repair of intact infrarenal abdominal aortic aneurysm.\",\"authors\":\"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen\",\"doi\":\"10.1016/j.surge.2024.10.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.</p><p><strong>Methods: </strong>Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p < 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.</p><p><strong>Conclusion: </strong>Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.</p>\",\"PeriodicalId\":49463,\"journal\":{\"name\":\"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-10-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.surge.2024.10.005\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.surge.2024.10.005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景：血管内动脉瘤修补术（EVAR）已成为治疗腹主动脉瘤（AAA）的主要方法。在 EVAR 中已观察到种族差异，但亚裔美国人在以前的研究中基本上被排除在外。本研究旨在利用多机构国家数据库，全面评估亚裔美国人因完整的肾下动脉瘤接受EVAR手术的30天结果：方法：从 ACS-NSQIP 数据库中筛选出 2012 年至 2022 年期间接受肾下动脉 AAA EVAR 手术的患者。排除标准包括年龄小于18岁、急诊就诊和术中急性转为开放手术。对亚裔美国人和白种人进行了1:3倾向得分匹配，以匹配他们的人口统计学特征、合并症、动脉瘤直径、动脉瘤远端范围、麻醉和伴随手术。结果：在16,463名因肾下动脉瘤未破裂而接受EVAR手术的患者中，302人（1.83%）为亚裔美国人，12,373人（75.16%）为白种人。亚裔美国人年龄较大，合并症较多。经过倾向分数匹配后，亚裔美国人和白种人患者的 30 天结果相当，包括死亡率（1.99 % vs 1.34 %，p = 0.42）、心脏并发症（2.32 % vs 1.56 %，p = 0.45）、肺部并发症（2.32 % vs 1.89 %，p = 0.64）和肾脏并发症（1.99 % vs 0.89 %，p = 0.13）。然而，亚裔美国人患者的手术时间更长（155.80 ± 84.59 vs 136.60 ± 69.60 分钟，p 结论：亚裔美国人患者的手术时间更长：亚裔美国人接受EVAR手术的人数可能不足，原因可能是医疗服务有限或疾病进展更隐匿。经过倾向分数匹配后，亚裔美国人的 30 天结果与白种人相似。因此，只要有机会，EVAR 对亚裔美国人患者同样有效和安全。未来的研究应调查亚裔美国人在EVAR术后的长期预后。
Thirty-day outcomes of Asian Americans in endovascular repair of intact infrarenal abdominal aortic aneurysm.
Background: Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.
Methods: Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.
Results: Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p < 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.
Conclusion: Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.
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Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field.
Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.
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