1
|
Johnson CT, Tran A, Preslar J, Bussey-Jones J, Schenker ML. Racial Disparities in the Operative Management of Orthopedic Trauma: A Systematic Review and Meta-Analysis. Am Surg 2023; 89:4521-4530. [PMID: 35981540 DOI: 10.1177/00031348221121561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to investigate if race is associated with the likelihood of operative management of acute fractures. METHODS A systematic review of the literature was performed using the PubMed, EMBASE, and Cochrane databases to identify studies associated with social disparities and acute orthopedic trauma. Peer-reviewed studies commenting on social disparities and the decision to pursue operative or non-operative management of acute fractures were identified for detailed review. Study characteristics and odds ratios were extracted from each article. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. A quality analysis of the data was also performed. RESULTS In total, 13 studies were identified and 8 were included in the meta-analysis totaling 743,846 fractures. Hip, distal radius, pelvic, tibial plateau, clavicle, femoral neck, and femoral shaft fractures were represented in this patient population. The meta-analysis demonstrated that White race is associated with a higher likelihood of operative intervention compared to all other races pooled together (odds ratio, 1.31; 95% confidence interval 1.16 to 1.47; p < .0001) as well as Black race (odds ratio 1.39; 95% confidence interval 1.12 to 1.72; p = .0025). CONCLUSIONS Non-White race and Black race are associated with a lower likelihood of receiving surgical management of acute orthopedic trauma. Surgeons and health systems should be aware of these inequities and consider strategies to mitigate bias and ensure all patients receive appropriate and timely care regardless of race.
Collapse
Affiliation(s)
| | - Andrew Tran
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jessie Preslar
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jada Bussey-Jones
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
2
|
Bartley CN, Atwell K, Purcell L, Cairns B, Charles A. Amputation Following Burn Injury. J Burn Care Res 2020; 40:430-436. [PMID: 31225899 DOI: 10.1093/jbcr/irz034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Amputation following burn injury is rare. Previous studies describe the risk of amputation after electrical burn injuries. Therefore, we describe the distribution of amputations and evaluate risk factors for amputation following burn injury at a large regional burn center. We conducted a retrospective analysis of patients ≥17 years admitted from January 2002 to December 2015. Patients who did and did not undergo an amputation procedure were compared. A multivariate logistic regression model was used to determine the risk factors for amputation. Amputations were further categorized by extremity location and type (major, minor) for comparison. Of the 8313 patients included for analysis, 1.4% had at least one amputation (n = 119). Amputees were older (46.7 ± 17.4 years) than nonamputees (42.6 ± 16.8 years; P = .009). The majority of amputees were white (47.9%) followed by black (39.5%) when compared with nonamputees (white: 57.1%, black: 27.3%; P = .012). The most common burn etiology for amputees was flame (41.2%) followed by electrical (23.5%) and other (21.9%). Black race (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.22-4.30; P = .010), electric (OR: 13.54; 95% CI: 6.23-29.45; P < .001) and increased %TBSA (OR: 1.03; 95% CI: 1.02-1.05; P < .001) were associated with amputation. Burn etiology, the presence of preexisting comorbidities, black race, and increased %TBSA increase the odds of post burn injury. The role of race on the risk of amputation requires further study.
Collapse
Affiliation(s)
- Colleen N Bartley
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| | - Kenisha Atwell
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| | - Laura Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| |
Collapse
|
3
|
de Jager E, Levine AA, Udyavar NR, Burstin HR, Bhulani N, Hoyt DB, Ko CY, Weissman JS, Britt LD, Haider AH, Maggard-Gibbons MA. Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map. J Am Coll Surg 2020; 228:276-298. [PMID: 30803548 DOI: 10.1016/j.jamcollsurg.2018.12.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Adele A Levine
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - N Rhea Udyavar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Nizar Bhulani
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Melinda A Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
| |
Collapse
|
4
|
Tse C, Grigorian A, Nahmias J, Kabutey NK, Schubl S, Beckord B, Bowens N, de Virgilio C. Racial Disparities in Limb Amputations After Traumatic Vascular Injury. J Clin Orthop Trauma 2019; 10:S100-S105. [PMID: 31700207 PMCID: PMC6823806 DOI: 10.1016/j.jcot.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The influence of race or ethnicity on limb loss after traumatic vascular injury is unclear. We sought to determine whether there were racial differences in rates of amputation between American Indians, blacks, Asians, and Hispanics compared to white patients following arterial axillosubclavian vessel injury (ASVI), femoral artery injury (FAI), or popliteal artery injury (PAI). As black race has been identified as an independent prognostic factor for postsurgical complication in trauma-associated lower extremity amputation, we further hypothesized that black race would be associated with a higher risk for limb loss after arterial ASVI, FAI, and PAI injury in a large national database. METHODS The National Trauma Data Bank was queried for patients ≥16-years-old with arterial ASVI, FAI, or PAI to determine the risk of arm, above knee amputation (AKA), and below knee amputation (BKA), respectively. Covariates were included in separate multivariable logistic regression models for analysis. The reference group included white trauma patients. RESULTS From 5,683,057 patients, 21,843 were identified with arterial ASVI, FAI, or PAI (<0.4%). For arterial ASVI, American Indian race was associated with higher risk for upper-extremity amputation as compared to white race (OR = 5.10, CI = 1.62-16.06, p < 0.05). For FAI, black race was associated with (OR = 0.66, CI = 0.49-0.89, p < 0.05) a lower risk of AKA, compared to white race. For PAI, race was not associated with risk for BKA. CONCLUSION Black race is associated with a lower risk of AKA after FAI, compared to whites. Race was not associated with a risk for limb loss after PAI. Future prospective studies examining socioeconomic factors and access to healthcare within this patient population is warranted to identify barriers and areas of improvement.
Collapse
Affiliation(s)
- Christina Tse
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
- Corresponding author. Division of Trauma, Burns and Surgical Critical Care Department of Surgery University of California, Irvine Medical Center 333 The City Blvd West, Suite 1600; Orange, CA, USA.
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Nii-Kabu Kabutey
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Sebastian Schubl
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Brian Beckord
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nina Bowens
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | | |
Collapse
|
5
|
Opel D, Rapone B, Krishnamoorthy B, Yoo J, Meeker J. Race and gender influence management of humerus shaft fractures. J Orthop 2018; 15:540-544. [PMID: 29881189 DOI: 10.1016/j.jor.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
This study examined the relationship of surgical management of humerus shaft fractures (HSFs) with race, gender, insurance status, and presence of lower extremity fracture in 19,818 patients from the National Trauma Data Bank years 2007-2012. Using a multivariate logistic regression model, black males (OR 0.73, 95% CI 0.66-0.81, p < 0.001) and white females (OR 0.85, 95% CI 0.80-0.91, p < 0.001) had reduced odds of surgery compared to white males. Insurance status was not significant. These disparities may reflect bias within the surgical treatment team.
Collapse
Affiliation(s)
- Dayton Opel
- Oregon Health & Science University, Department of Orthopaedics and Rehabilitation, Sam Jackson Hall, Ste 2360, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Benjamin Rapone
- Department of Mathematics, Washington State University, PO Box 643113, Pullman, WA, 99164-3113, United States
| | - Bala Krishnamoorthy
- Department of Mathematics, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, United States
| | - Jung Yoo
- Sam Jackson Hall, Ste 2360, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - James Meeker
- Sam Jackson Hall, Ste 2360, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| |
Collapse
|