Institutions with more racially diverse, uninsured patients linked with surgical delays
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Regardless of race, patients who sought surgery from an institution with a greater proportion of racially diverse and uninsured patients were more likely to experience surgical delays greater than the 24-hour benchmark, results showed.
To study disparities in meeting fracture care time-to-surgery benchmarks, researchers performed a secondary analysis of multicenter data on 2,565 patients (mean age of 64.5 years) who sought surgery for a hip or femur fracture from 2018 to 2021 with 1 year of follow-up. The primary outcome measure was time to surgery based on a 24-hour time-to-surgery benchmark. Researchers also performed multilevel, multivariate regression to evaluate the association between race, ethnicity and insurance status with time to surgery.
Overall, 3.2% of patients were Asian; 13.4% were Black; 82.3% were white; and 1.1% were “other” race. Of these patients, 92.2% (n= 2,367) had medical insurance.
Researchers found 23.2% of patients (n = 596) did not meet the 24-hour time-to-surgery benchmark. Multivariate regression revealed an independent association between missing the 24-hour benchmark for time-to-surgery and hospital population insurance coverage (odds ratio [OR] = 0.94; 95%CI, 0.89-0.98). Researchers found a similar association between hospital population insurance coverage and the racial diversity of patients (OR = 1.03; 95% CI, 1.01-1.05); however, they found no association between patient race and surgical delays beyond the 24-hour benchmark (OR = 0.96; 95%CI, 0.72-1.29).
“Institutions that treat a less diverse patient population appeared to be more resilient to the mix of insurance status in their patient population and were more likely to meet time-to-surgery benchmarks, regardless of patient insurance status or population-based insurance mix,” the researchers wrote in the study.
“While increased delays in association with a poorer payer mix would not be surprising, the fact that delays are only seen in association with a more racially diverse patient population can only be explained by structural health systems issues,” they concluded.
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