Abstract：
BACKGROUND: Racial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation.
METHODS: Patients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted.
RESULTS: 5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index.
CONCLUSIONS: Fewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.
METHODS: Patients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted.
RESULTS: 5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index.
CONCLUSIONS: Fewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.
摘要：
背景：骨科手术中的种族和种族差异是有据可查的。然而,这些在骨折治疗中持续存在的程度尚不清楚.这项研究旨在评估骨干胫骨骨折固定术后患者术后手术和医疗管理的种族差异。
方法：2015年10月1日至2020年12月31日经手术治疗的胫骨干骨折患者在MarketScan®Medicaid数据库中被确认。排除标准包括并发骨折或截肢。结果包括术后2年并发症，再操作率,并填写处方。手术治疗的黑人和白人队列使用最近邻匹配对患者人口统计学进行倾向评分匹配，合并症,骨折模式和严重程度，和固定类型。进行卡方检验和生存分析（Kaplan-Meier和Cox比例风险模型）。
结果：纳入了5,472例患者，2,209名黑人和3,263名白人患者。匹配后,每个队列中保留了2,209。在匹配的Black和White队列中，没有观察到并发症发生率的显着差异。再操作率,然而,与白人患者相比，黑人患者明显更低(28.5%vs.率35.5%,风险差异=7.0%（95%置信区间（CI）：4.2%至9.7%）。Black（17.9％）的植入物去除率也显着较低。白人（25.1%）患者（风险差异=7.2%，（95CI：4.8%至9.6%）。黑人与白人患者的再手术率比较调整后的风险比为0.77（95CI：0.69-0.82，p<0.0001）。黑人与白人患者的比例明显较低，至少服用了一种苯二氮卓类药物的处方，抗抑郁药,强鸦片,或抗生素在索引后的每个时间点。
结论：黑色和白色医疗补助保险患者胫骨干骨折手术治疗后，使用的资源较少。这些结果可能反映了Black患者胫骨骨折手术后并发症的治疗不足，并强调需要进一步干预以解决创伤护理中的种族差异。
方法：2015年10月1日至2020年12月31日经手术治疗的胫骨干骨折患者在MarketScan®Medicaid数据库中被确认。排除标准包括并发骨折或截肢。结果包括术后2年并发症，再操作率,并填写处方。手术治疗的黑人和白人队列使用最近邻匹配对患者人口统计学进行倾向评分匹配，合并症,骨折模式和严重程度，和固定类型。进行卡方检验和生存分析（Kaplan-Meier和Cox比例风险模型）。
结果：纳入了5,472例患者，2,209名黑人和3,263名白人患者。匹配后,每个队列中保留了2,209。在匹配的Black和White队列中，没有观察到并发症发生率的显着差异。再操作率,然而,与白人患者相比，黑人患者明显更低(28.5%vs.率35.5%,风险差异=7.0%（95%置信区间（CI）：4.2%至9.7%）。Black（17.9％）的植入物去除率也显着较低。白人（25.1%）患者（风险差异=7.2%，（95CI：4.8%至9.6%）。黑人与白人患者的再手术率比较调整后的风险比为0.77（95CI：0.69-0.82，p<0.0001）。黑人与白人患者的比例明显较低，至少服用了一种苯二氮卓类药物的处方，抗抑郁药,强鸦片,或抗生素在索引后的每个时间点。
结论：黑色和白色医疗补助保险患者胫骨干骨折手术治疗后，使用的资源较少。这些结果可能反映了Black患者胫骨骨折手术后并发症的治疗不足，并强调需要进一步干预以解决创伤护理中的种族差异。
