Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures
Category: Trauma; Ankle; Hindfoot; Other Introduction/Purpose: Race-based differences in the surgical management of hip fractures are well-established. Studies assessing these disparities for below-knee fractures have yet to be conducted despite their high volume. Our purpose was to determine whethe...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-11-01
|
| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011421S01007 |
| _version_ | 1798015820250480640 |
|---|---|
| author | Amy L. Xu BS Micheal Raad Babar Shafiq Umasuthan Srikumaran Amiethab A. Aiyer MD |
| author_facet | Amy L. Xu BS Micheal Raad Babar Shafiq Umasuthan Srikumaran Amiethab A. Aiyer MD |
| author_sort | Amy L. Xu BS |
| collection | DOAJ |
| description | Category: Trauma; Ankle; Hindfoot; Other Introduction/Purpose: Race-based differences in the surgical management of hip fractures are well-established. Studies assessing these disparities for below-knee fractures have yet to be conducted despite their high volume. Our purpose was to determine whether 1) early postoperative complications and 2) time to surgery for operative fixation of below-knee fractures differ for black versus white patients, and to assess whether disparities exist between fracture subtypes. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients (>=18 years) undergoing open fixation of below-knee fractures between 2010-2019. This yielded 9,172 patients; 1,120 (12%) were black. We collected patient demographics and preoperative risk factors. Primary outcomes were 30-day postoperative complications and time to surgical fixation. Fractures were further subclassified as tibia and/or fibula shaft, isolated malleolar, bi/trimalleolar, and pilon fractures. Nearest-neighbor propensity score matching in a 1:1 ratio was applied to compare outcomes by race. Alpha = 0.05. Results: After matching, we identified 1,120 white patients with equal propensity scores as our black patients. Black patients had 1.5 times higher odds (95% confidence interval [CI]: 1.0-2.0) of experiencing any early adverse event when compared with matched white counterparts. Blacks also had 1.9 times higher odds (95% CI: 1.2-3.0) of requiring unplanned readmission within 30 days of operative fixation. Fifty-eight black patients (5.3%) required short-term readmission, compared with 351 white patients (4.5%) - 32 (2.9%) in the matched cohort. The most common reasons for readmission were wound, gastrointestinal, thromboembolic, and recurrent musculoskeletal complications for both races. There were no significant differences by race in time to surgery. Fracture subtype was not associated with postoperative complications or time to surgery in the multivariable analysis. Conclusion: Racial disparities in the early postoperative course after open fixation of below-knee fractures exist, with significantly higher rates of early adverse events and unplanned readmission for black versus white patients that persist after propensity matching. These trends may be secondary to a host of community- and hospital-level factors, illustrating the importance of interventions that consider the differences between hip and non-hip fractures and increase resources to vulnerable areas. |
| first_indexed | 2024-04-11T15:40:53Z |
| format | Article |
| id | doaj.art-e873a014e478415ba1bdd34ffb92b95f |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-11T15:40:53Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-e873a014e478415ba1bdd34ffb92b95f2022-12-22T04:15:50ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142022-11-01710.1177/2473011421S01007Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee FracturesAmy L. Xu BSMicheal RaadBabar ShafiqUmasuthan SrikumaranAmiethab A. Aiyer MDCategory: Trauma; Ankle; Hindfoot; Other Introduction/Purpose: Race-based differences in the surgical management of hip fractures are well-established. Studies assessing these disparities for below-knee fractures have yet to be conducted despite their high volume. Our purpose was to determine whether 1) early postoperative complications and 2) time to surgery for operative fixation of below-knee fractures differ for black versus white patients, and to assess whether disparities exist between fracture subtypes. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients (>=18 years) undergoing open fixation of below-knee fractures between 2010-2019. This yielded 9,172 patients; 1,120 (12%) were black. We collected patient demographics and preoperative risk factors. Primary outcomes were 30-day postoperative complications and time to surgical fixation. Fractures were further subclassified as tibia and/or fibula shaft, isolated malleolar, bi/trimalleolar, and pilon fractures. Nearest-neighbor propensity score matching in a 1:1 ratio was applied to compare outcomes by race. Alpha = 0.05. Results: After matching, we identified 1,120 white patients with equal propensity scores as our black patients. Black patients had 1.5 times higher odds (95% confidence interval [CI]: 1.0-2.0) of experiencing any early adverse event when compared with matched white counterparts. Blacks also had 1.9 times higher odds (95% CI: 1.2-3.0) of requiring unplanned readmission within 30 days of operative fixation. Fifty-eight black patients (5.3%) required short-term readmission, compared with 351 white patients (4.5%) - 32 (2.9%) in the matched cohort. The most common reasons for readmission were wound, gastrointestinal, thromboembolic, and recurrent musculoskeletal complications for both races. There were no significant differences by race in time to surgery. Fracture subtype was not associated with postoperative complications or time to surgery in the multivariable analysis. Conclusion: Racial disparities in the early postoperative course after open fixation of below-knee fractures exist, with significantly higher rates of early adverse events and unplanned readmission for black versus white patients that persist after propensity matching. These trends may be secondary to a host of community- and hospital-level factors, illustrating the importance of interventions that consider the differences between hip and non-hip fractures and increase resources to vulnerable areas.https://doi.org/10.1177/2473011421S01007 |
| spellingShingle | Amy L. Xu BS Micheal Raad Babar Shafiq Umasuthan Srikumaran Amiethab A. Aiyer MD Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures Foot & Ankle Orthopaedics |
| title | Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures |
| title_full | Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures |
| title_fullStr | Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures |
| title_full_unstemmed | Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures |
| title_short | Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures |
| title_sort | racial disparities in early adverse events and unplanned readmission after open fixation of below knee fractures |
| url | https://doi.org/10.1177/2473011421S01007 |
| work_keys_str_mv | AT amylxubs racialdisparitiesinearlyadverseeventsandunplannedreadmissionafteropenfixationofbelowkneefractures AT michealraad racialdisparitiesinearlyadverseeventsandunplannedreadmissionafteropenfixationofbelowkneefractures AT babarshafiq racialdisparitiesinearlyadverseeventsandunplannedreadmissionafteropenfixationofbelowkneefractures AT umasuthansrikumaran racialdisparitiesinearlyadverseeventsandunplannedreadmissionafteropenfixationofbelowkneefractures AT amiethabaaiyermd racialdisparitiesinearlyadverseeventsandunplannedreadmissionafteropenfixationofbelowkneefractures |