Racial, ethnic disparities for patients exist in use of open reduction, internal fixation
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Key takeaways:
- Black and Hispanic patients had a lower utilization of open reduction and internal fixation compared with white patients.
- Disparities were not presented in Medicare-eligible patients aged 65 years or older.
Published results showed Black and Hispanic patients had lower utilization of open reduction and internal fixation surgery for distal radius fractures compared with white patients.
Trista M. Benítez, MPH, and colleagues from the University of Michigan analyzed retrospective data from 26,874 patients (mean age of 64.6 years) who underwent surgery for a distal radius fracture between Jan. 1, 2016, and Nov. 30, 2019.
According to the study, 14,037 patients (52.2%) were at least 65 years old and eligible for Medicare; 2,805 patients (10.4%) were Hispanic; 1,492 patients (5.6%) were Black; 20,548 patients (76.5%) were white; and 2,029 patients (7.6%) were categorized as another race or ethnicity.
Overall, 32.6% of patients underwent open reduction and internal fixation (ORIF). Among these patients, 20.2% were Black, 25.8% were Hispanic and 35.4% were white. Researchers noted this disparity in utilization of ORIF for Black patients (OR = 0.6) and Hispanic patients (OR = 0.82) compared with white patients was confirmed with multivariable logistic regression analysis.
Researchers found the expected disparity between Black patients and white patients aged 65 years old without Medicare coverage was 12.6 percentage points, while the actual disparity was 22 percentage points.
“Findings of this study suggest that despite less confounding from insurance after age 65 years, there remains substantially lower use of surgical management for distal radius fractures in racial or ethnic minority patients,” the researchers wrote in the study.
Perspective
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It was a privilege to read the recent study by Trista M. Benítez, MPH, and colleagues that found that Black and Hispanic patients were less likely to undergo surgical treatment of distal radius fractures, with this disparity persisting after Medicare coverage began after the age of 65 years. We are becoming increasingly aware of health care disparities in orthopedic surgery and hand surgery, especially in how it can detrimentally affect patients and their outcomes. We are hopeful that this type of work continues to be surfaced, and that it motivates interventions that target the structural barriers and implicit bias that limit equitable, high-quality care for all patients, regardless of race, ethnicity or sex. At Stanford, we have created the Surgical Wait Time for Fracture Treatment (SWIFT) initiative, a multicenter collaboration working with 26 hospitals across the country to improve time to surgery for patients with hip fracture, including addressing care disparities in Black and Asian patients. We are excited to see more literature on how to address these biases and look forward to reading and publishing studies in the future that highlight how racial disparities in orthopedic surgery no longer exist.
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