Objective To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States. Design Retrospective cohort study. Setting US, 2016-18. Participants 1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection. Main outcome measure The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure. Results Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery. Conclusions Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face. The Medicare data cannot be shared.

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美国不同种族和性别的手术结果不平等：回顾性队列研究

目的 评估美国八种常见外科手术（择期和非择期）在种族和性别方面的死亡率不平等现象。设计回顾性队列研究。设定美国，2016-18 年。参与者 1 868 036 名 65-99 岁的黑人和白人 Medicare 受益人正在接受八种常见手术之一：腹主动脉瘤修复术、阑尾切除术、胆囊切除术、结肠切除术、冠状动脉旁路手术、髋关节置换术、膝关节置换术和肺切除术。主要结果指标 主要结果指标是 30 天死亡率，定义为住院期间或手术后 30 天内死亡。结果 与白人男性（21833 例死亡，2.69%，95% 置信区间 2.85% 至 3.24%）相比，黑人男性术后死亡率总体较高（1698 例死亡，调整后死亡率 3.05%，95% 置信区间 2.85% 至 3.24%）2.65% 至 2.73%）、白人女性（21847 人死亡，2.38%、2.35% 至 2.41%）和黑人女性（1631 人死亡，2.18%、2.04% 至 2.31%），针对潜在混杂因素进行调整后。择期手术也发现了类似的模式，与白人男性（5650 例死亡，0.85%、0.83% 至 0.88%）相比，黑人男性显示出更高的调整后死亡率（393 例死亡，1.30%、1.14% 至 1.46%）、白人女性（4615 人死亡，0.82%，0.80% 至 0.84%）和黑人女性（359 人死亡，0.79%，0.70% 至 0.88%）。这 0.45 个百分点的差异意味着黑人男性与白人男性相比，择期手术后的死亡率高 50%。然而，对于非选择性手术，黑人男性和白人男性的死亡率没有差异（1305 例死亡，6.69%、6.26% 至 7.11%；以及 16183 例死亡，分别为 7.03%、6.92% 至 7.14%），尽管白人女性和黑人女性的死亡率较低（17232 人死亡，分别为 6.12%、6.02% 至 6.21%；以及 1272 人死亡，分别为 5.29%、4.93% 至 5.64%）。这些死亡率差异出现在手术后 7 天内，并持续长达手术后 60 天。结论 与白人男性、白人女性和黑人女性相比，黑人男性的总体术后死亡率更高。这些发现强调需要更好地了解需要手术的黑人男性所面临的独特挑战。无法共享 Medicare 数据。白人妇女和黑人妇女。这些发现强调需要更好地了解需要手术的黑人男性所面临的独特挑战。无法共享 Medicare 数据。白人妇女和黑人妇女。这些发现强调需要更好地了解需要手术的黑人男性所面临的独特挑战。无法共享 Medicare 数据。