系统性综述:研究美国社会经济状况对动脉粥样硬化症血管重建术、颈动脉手术和主动脉瘤修补术结果的影响》(A Systematic Review to Examine the Impact of Socioeconomic Status on Revascularization for PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States)。
Ahsan Zil E Ali, Billal Alamarie, Leana Dogbe, Alpha Tall, Abdul Wasay Paracha, Faisal Aziz
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The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. It included studies reporting socioeconomic factors, income, social determinants of health, social class, and health status disparities in patients undergoing vascular surgical procedures. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. 1,133 studies were initially selected and only 19 passed the complete inclusion criteria for final assessment and reporting.</p><p><strong>Results: </strong>A total of 19 studies were examined that assessed the relationship between socioeconomic status and vascular surgery outcomes. All analyses were published between 2018-2023 and included a broad spectrum of patients undergoing multiple vascular procedures. 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引用次数: 0
摘要
目的:本系统性综述旨在研究美国现有的关于SES对外周动脉疾病(PAD)、颈动脉疾病和主动脉瘤手术效果影响的文献。该综述还旨在报告血管外科文献中用于计算 SES 的各种工具:在英文文献综述的基础上,使用文献数据库 PubMed 和 Scopus 对从开始到 2023 年 11 月的英文文献进行了系统性综述。该综述是根据系统综述和元分析首选报告项目(PRISMA)指南设计的。其中包括报告接受血管外科手术患者的社会经济因素、收入、健康的社会决定因素、社会阶层和健康状况差异的研究。利用非随机干预研究中的偏倚风险(ROBINS-I)工具对偏倚风险进行了评估。初步筛选出 1,133 项研究,只有 19 项通过了最终评估和报告的完整纳入标准:共考察了19项评估社会经济地位与血管外科手术结果之间关系的研究。所有分析均发表于2018-2023年间,纳入了接受多种血管手术的广泛患者。共有10篇论文探讨了这些因素在PAD患者中的作用,3篇分析了这些因素在颈动脉疾病患者中的影响,6篇探讨了这些因素在主动脉修复患者中的作用。所选研究均未报告高偏倚风险,且大多数研究(15/19)均基于国家或大型登记处。这些研究结果显示了广泛的 SES 报告措施。所报告的研究结果表明,较低的社会经济地位与截肢和中风风险较高有关,而截肢和中风风险较高的原因是PAD和颈动脉手术后进行了血管重建。在接受主动脉修补术的患者中,SES较低者更有可能出现动脉瘤破裂或在手术时出现症状。.结论:血管外科文献中使用了多种指标来评估社会经济地位。所有研究都将较低的社会经济地位与较差的治疗效果或较严重的症状联系在一起,这些症状包括PAD、颈动脉疾病和主动脉修补术。这凸显了在改善手术效果和减少医疗差距时考虑社会经济地位的必要性。
A Systematic Review to Examine the Impact of Socioeconomic Status on Revascularization for PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States.
Objective: This systematic review aims to study the available literature on the impact of SES on the surgical outcomes of peripheral arterial disease (PAD), carotid artery disease, and aortic aneurysms in the United States. The review also aims to report the diverse tools utilized to compute SES within the vascular surgery literature.
Methods: A systematic review of English literature was conducted based on the English literature review using literature databases PubMed and Scopus from inception till November 2023. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. It included studies reporting socioeconomic factors, income, social determinants of health, social class, and health status disparities in patients undergoing vascular surgical procedures. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. 1,133 studies were initially selected and only 19 passed the complete inclusion criteria for final assessment and reporting.
Results: A total of 19 studies were examined that assessed the relationship between socioeconomic status and vascular surgery outcomes. All analyses were published between 2018-2023 and included a broad spectrum of patients undergoing multiple vascular procedures. A total of 10 publications addressed the role of these factors in patients with PAD, 3 analyzed the impact of these factors in patients with Carotid Artery Disease, and 6 explored the role of these factors in patients with aortic repairs. No high risk of bias was reported for any selected study, and most studies (15/19) were based on national or large registries. The results of these studies showed widespread reporting measures of SES. The findings reported describe that lower SES is associated with a higher risk of amputation and stroke following revascularization for PAD and carotid artery surgery. Among the patients undergoing aortic repair, lower SES was more likely to present with ruptured aneurysms or symptomatic at the time of surgery. .
Conclusion: Multiple metrics are utilized to assess SES in the vascular surgery literature. All studies associated lower SES with poorer outcomes or higher acuity of symptoms at the time of revascularization for PAD, Carotid Artery Disease, and aortic repair.. This highlights the need to consider SES in improving surgical outcomes and reducing healthcare disparities.
期刊介绍:
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.