BACKGROUND Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis. METHODS This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021. Patients were categorized as non-Hispanic White (hereafter, White), non-Hispanic Black (hereafter, Black), Asian, and Hispanic individuals. The association between (1) FTR after sepsis and (2) FTR after septic shock and race and ethnicity was evaluated using multivariable logistic regression. Failure-to-rescue was defined as 30-day mortality among patients who developed postoperative sepsis or postoperative septic shock. RESULTS Among the 1388,977 patients (mean [SD] age 60.5 [16]); 783,056 (56.4%) were female, 1017,875 (73%) were White, 171,774 (12%) were Black, 138,457 (10%) were Hispanic, and 60,871 (4%) were Asian. Compared to White individuals, Black (adjusted odds ratio [aOR], 1.29; 95% CI, 1.23-1.35, P < .001) and Hispanic individuals (aOR, 1.15; 95% CI, 1.09-1.21, P < .001) were more likely to develop sepsis; Black individuals were more likely to develop septic shock (aOR, 1.28; 95% CI, 1.21-1.36; P < .001), and Asians were less likely to develop septic shock (aOR 0.84; 95% CI, 0.75-0.93, P = .002). Black individuals experienced lower rates of FTR after sepsis [Black: (aOR, 0.71; 95% CI, 0.54-0.94; P = .017), while Black (aOR, 0.93; 95% CI, 0.80-1.08; P = .35)], Hispanic (aOR, 0.87; 95% CI, 0.72-1.06; P = .16) and Asian Individuals (aOR, 1.06; 95% CI, 0.8-1.37; P = .67) experienced similar rates of FTR after septic shock compared to White individuals. CONCLUSIONS Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.

中文翻译：

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非心脏手术后脓毒症术后抢救失败的种族和民族差异。


背景 脓毒症对边缘化社区的影响尤为严重。本研究旨在评估脓毒症术后抢救失败 （FTR） 的种族和民族差异。方法 这项横断面研究使用了来自美国外科医师学会国家手术质量改进计划的数据，该计划针对 2018 年至 2021 年间接受住院非心脏手术的患者。患者被分为非西班牙裔白人 （以下简称白人）、非西班牙裔黑人 （以下简称黑人）、亚裔和西班牙裔个体。使用多变量 logistic 回归评估 （1） 脓毒症后 FTR 和 （2） 感染性休克后 FTR 与种族和民族之间的关联。抢救失败定义为术后脓毒症或术后脓毒性休克患者的 30 天死亡率。结果 在 1388,977 例患者中 （平均 [SD] 年龄 60.5 [16]）;783,056 人 （56.4%） 为女性，1017,875 人 （73%） 为白人，171,774 人 （12%） 为黑人，138,457 人 （10%） 为西班牙裔，60,871 人 （4%） 为亚裔。与白人个体相比，黑人 （校正比值比 [aOR]，1.29;95% CI，1.23-1.35，P < .001）和西班牙裔个体 （aOR，1.15;95% CI，1.09-1.21，P < .001） 更容易患败血症;黑人个体更容易发生感染性休克 （aOR， 1.28;95% CI， 1.21-1.36;P < .001），亚洲人发生脓毒性休克的可能性较小 （aOR 0.84;95% CI，0.75-0.93，P = .002）。黑人个体在脓毒症后的 FTR 发生率较低 [黑人：（aOR，0.71;95% CI，0.54-0.94;P = .017），而黑人 （aOR， 0.93;95% CI， 0.80-1.08;P = .35）]]，西班牙裔 （aOR，0.87;95% CI，0.72-1.06;P = .16）和亚洲个体 （aOR， 1.06;95% CI， 0.8-1.37;P = .67） 与白人个体相比，感染性休克后 FTR 发生率相似。 结论 黑人和西班牙裔个体术后脓毒症发生率较高，但抢救失败率不高。减少外科护理中的不平等应侧重于预防术后脓毒症的努力。