Sex-Specific Analysis at Two Time Points in Three High-Impact Orthopaedic Sports Medicine Journals

Epidemiologic characteristics of 22,086 patients discharged from the Department of Orthopaedic Trauma at a military hospital between 2013 and 2022: a retrospective real-world study

BACKGROUND

To analyse the epidemiological characteristics of orthopaedic trauma patients and thereby optimize healthcare resource allocation and improve treatment efficiency.

MATERIALS AND METHODS

Relying on the hospital information system (HIS) database, we retrospectively analysed the epidemiological characteristics of orthopaedic trauma inpatients in our hospital between 2013 and 2022, including patient demographic information, causes of injury, location of injury and hospitalization costs.

RESULTS

The median age of the patients was 36 (26-47) years old; the age stratification of the patients was highest in the proportion of patients aged 40-50 years old (29.23%); hypertension was the most common among the patients' comorbidities (1.29%); patients' occupation was highest in heavy labourers such as farmers and workers, about 63.04% (n = 13923); patients' admissions were mainly in the form of emergencies (n = 16875, 76.41%); and patients' median hospitalization time was 7 (5, 12) days. The highest percentage of the cause of injury was due to exposure to inanimate mechanical forces (75.4%), followed by falls (16.14%) and traffic accidents (6.49%). The highest percentage of cause of injury in all age groups was due to inanimate mechanical force, and the percentage of patients with falls increased with age, and there was a positive correlation between age groups and the percentage of patients with falls (r = 0.964, p < 0.01). The highest percentage of patients with injuries to the upper extremities was about 74%. The distribution of injury sites in all age groups was highest in the upper extremities. Age was positively correlated with trunk injuries (r = 0.469, p = 0.203). The median hospitalization cost for patients over a 10-year period was approximately $1,100.

CONCLUSIONS

By analysing the epidemiological characteristics of patients, a general profile of local orthopaedic trauma patients was established, which can help in the development of disease prevention and interventions.

The Role of Institutional Review Boards in Improving the Inclusion of Sex and Gender as Variables in Clinical Research

ABSTRACT

In orthopaedic clinical research, as in other fields, sex and gender-specific analyses are not consistently performed, despite evidence of sex differences in outcomes. Both institutional review boards (IRBs) and journal editors have a role in impacting the rate at which such analyses are performed and reported. The authority, responsibilities, and potential actions of IRBs are discussed herein, with the aim of setting investigator expectations and propelling changes to the study plan before the research is initiated.

Rates of Reporting and Analyzing Patient Sex in Sports Medicine Research: A Systematic Review

BACKGROUND

Sex differences in sports medicine are well documented. However, no studies to date have reviewed the rate at which sex is reported and analyzed in the athlete-specific orthopaedic sports medicine literature.

PURPOSE

To determine the rates of reporting and analyzing patient sex in athlete-specific sports medicine literature.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

Articles published by the 3 journals of the AOSSM (American Journal of Sports Medicine [AJSM], Orthopaedic Journal of Sports Medicine, and Sports Health: A Multidisciplinary Approach) between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that isolated athletes were included. Studies that isolated sports that are predominantly single sex at the college and/or professional levels (football, baseball, softball, and wrestling) were excluded.

RESULTS

Of the 5140 publications screened, 559 met the inclusion criteria. In total, 93.9% of all studies reported patient sex, and 34.7% of all studies analyzed patient sex. However, 143 studies only included males and 50 studies only included females (n = 193). When excluding these single-sex studies, analysis of the remaining 366 studies found that the rate of sex-specific analysis increased to 53.0%. Rates of reporting patient sex did not significantly differ by journal or by year. Similarly, rates of analyzing patient sex did not differ by year, but Sports Health analyzed sex the most frequently, and AJSM analyzed sex the least frequently (P = .002). Studies that isolated college (84.1%), youth (66.7%), or recreational (52.6%) athletes analyzed sex at or above the overall rate of 53.0%, but studies of elite athletes (35.7%) tended to analyze sex less frequently.

CONCLUSION

Patient sex is well reported in the athlete-specific sports medicine literature (93.9% of included studies reported sex), demonstrating that most studies include sex as a demographic variable. However, patient sex was analyzed only in 53.0% of studies that included both male and female patients. Given that athlete-specific sex differences are known to exist within the field of sports medicine, many studies that could benefit from using patient sex as a variable for analysis likely fail to do so.

Current Concept Review: Inclusion and Analysis of Diverse Study Populations in Orthopaedic Research

As disparities in healthcare access and outcomes have been increasingly identified across medical specialties, the importance of recognizing and understanding the diversity of our patient populations and the influence of individual characteristics such as age, sex, gender, race, and ethnicity on clinical outcomes has been emphasized. Orthopaedic literature has advanced dramatically in the quality and quantity of research generated over the past 25 years, yet a consistent, sustained focus on studying musculoskeletal health in the context of these unique patient-specific variables has not been maintained. The result of this inattention may be the provision of orthopaedic care that is ill-suited for the individual patient whose biologic characteristics, life experiences, and cultural constructs differ from that of the typical research subject. The recent proliferation of meta-analyses-whose intention is to optimize statistical power-likely compounds the problem because improper, inconsistent, or absent categorization of patients in research articles precludes meaningful subgroup analysis. This article describes the current variability in demographic reporting in the orthopaedic literature, highlights the importance of complete, consistent demographic reporting and subgroup analysis, and reviews specific examples of orthopaedic conditions that illustrate how clinical outcomes may be affected by patient-specific variables such as age, sex, gender, race, and ethnicity.

Sex-Specific Analysis Is Lacking in Abstracts Presented at Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019

Purpose

To evaluate the presence of sex-specific analysis (SSA) in abstracts accepted for podium presentation at the Arthroscopy Association of North America (AANA) and American Orthopaedic Society for Sports Medicine (AOSSM) annual meetings from 2016 to 2019.

Methods

Abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019 were selected for review. Studies that included sex as a variable in a multifactorial statistical model were considered to have performed adequate SSA. Secondary data collected included whether the abstract had a female lead or senior author, the degrees of the female authors, and the anatomic focuses of studies with SSA.

Results

Of the 891 total abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019, 90 (10%) included SSA. There were 284 AANA abstracts, 24 (8%) of which reported SSA. Of the 607 AOSSM abstracts, 66 (11%) reported SSA. There were 43 female first authors (15%) and 33 female senior authors (12%) of the AANA abstracts compared with 92 female first authors (15%) and 39 female senior authors (6%) of the AOSSM abstracts. Of the 891 total abstracts, 135 (15%) listed a female lead author and 72 (8%) had a female senior author. Of the 135 female first authors, 92 (68%) had an M.D., whereas 40 of the 72 female senior authors (56%) had an M.D. Analysis of all abstracts combined showed a positive correlation between SSA and a female first author (Pearson correlation coefficient = 0.035, P = .147), as well as between SSA and a female senior author (Pearson correlation coefficient = 0.052, P = .059).

Conclusions

From 2016 to 2019, only 10% of abstracts accepted for podium presentation at the AANA and AOSSM annual meetings included SSA. Altogether, women represented 15% of first authors and 8% of senior authors.

Clinical Relevance

This study highlights the low percentage of SSA in abstracts presented at the AANA and AOSSM annual meetings from 2016 to 2019. Future studies should attempt to perform SSA when relevant to better evaluate differences in outcomes between male and female patients.