Objective: 

To evaluate whether patients of Black race are at higher risk of adverse postoperative discharge to a nursing home, and if a higher prevalence of severe diabetes mellitus and hypertension are contributing.

Background: 

It is unclear whether a patient’s race predicts adverse discharge to a nursing home after surgery, and if preexisting diseases are contributing.

Methods: 

A total of 368,360 adults undergoing surgery between 2007 and 2020 across 2 academic healthcare networks in New England were included. Patients of self-identified Black or White race were compared. The primary outcome was postoperative discharge to a nursing facility. Mediation analysis was used to examine the impact of preexisting severe diabetes mellitus and hypertension on the primary association.

Results: 

In all, 10.3% (38,010/368,360) of patients were Black and 26,434 (7.2%) patients were discharged to a nursing home. Black patients were at increased risk of postoperative discharge to a nursing facility (adjusted absolute risk difference: 1.9%; 95% confidence interval: 1.6%–2.2%; P<0.001). A higher prevalence of preexisting severe diabetes mellitus and hypertension in Black patients mediated 30.2% and 15.6% of this association. Preoperative medication-based treatment adherent to guidelines in patients with severe diabetes mellitus or hypertension mitigated the primary association (P-for-interaction <0.001). The same pattern of effect mitigation by pharmacotherapy was observed for the endpoint 30-day readmission.

Conclusions: 

Black race was associated with postoperative discharge to a nursing facility compared to White race. Optimized preoperative assessment and treatment of diabetes mellitus and hypertension improves surgical outcomes and provides an opportunity to the surgeon to help eliminate healthcare disparities.

中文翻译：

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严重糖尿病和高血压的术前治疗可减轻医疗保健差异并防止术后出院到疗养院的不良反应

客观的： 

评估黑人患者术后出院到疗养院的风险是否较高，以及是否有较高的严重糖尿病和高血压患病率起作用。

背景： 

目前尚不清楚患者的种族是否预示着手术后会出现不良出院，以及先前存在的疾病是否有影响。

方法： 

包括 2007 年至 2020 年间在新英格兰的 2 个学术医疗保健网络中接受手术的总共 368,360 名成年人。对自我认同的黑人或白人种族的患者进行了比较。主要结果是术后出院到护理机构。中介分析用于检查先前存在的严重糖尿病和高血压对主要关联的影响。

结果： 

总共有 10.3% (38,010/368,360) 的患者是黑人，26,434 (7.2%) 名患者出院到疗养院。黑人患者术后出院到护理机构的风险增加（调整后的绝对风险差：1.9%；95% 置信区间：1.6%–2.2%；P <0.001）。黑人患者先前存在的严重糖尿病和高血压的较高患病率介导了这种关联的 30.2% 和 15.6%。在严重糖尿病或高血压患者中遵守指南的术前药物治疗减轻了主要关联（P -for-interaction <0.001）。在终点 30 天再入院观察到相同的药物治疗缓解效应模式。

结论： 

与白人相比，黑人与术后出院到护理机构有关。糖尿病和高血压的优化术前评估和治疗改善了手术结果，并为外科医生提供了帮助消除医疗保健差异的机会。