Department of Orthopaedic Surgery, George Washington Hospital.
Weill Cornell Medical College, New York, NY.
J Pediatr Orthop. 2022;42(5):e403-e408. doi: 10.1097/BPO.0000000000002102.
Developmental dysplasia of the hip in pediatric patients can be managed conservatively or operatively. Understanding patient risk factors is important to optimize outcomes following surgical treatment of developmental dysplasia of the hip. Racial disparities in procedural outcomes have been studied, however, there is scarce literature on an association between race and complications following pediatric orthopaedic surgery. Our study aimed to determine the association between pediatric patients' race and outcomes following operative management of hip dysplasia by investigating 30-day postoperative complications and length of hospital stay.
The National Surgical Quality Improvement Program-Pediatric database was utilized from the years 2012 to 2019 to identify all pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into 2 groups: patients who were White and patients from underrepresented minority (URM) groups. URM groups included those who were Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Differences in patient demographics, comorbidities, and postoperative outcomes were compared between the 2 cohorts using bivariate and multivariate analyses.
Of the 9159 pediatric patients who underwent surgical treatment for hip dysplasia between 2012 and 2019, 6057 patients (66.1%) were White and 3102 (33.9%) were from URM groups. In the bivariate analysis, compared with White patients, patients from URM groups were more likely to experience deep wound dehiscence, pneumonia, unplanned reintubation, cardiac arrest, and extended length of hospital stay. Following multivariate analysis, patients from URM groups had an increased risk of unplanned reintubation (odds ratio: 3.583; P=0.018).
Understanding which patient factors impact surgical outcomes allows health care teams to be more aware of at-risk patient groups. Our study found that pediatric patients from URM groups who underwent surgery for correction of hip dysplasia had greater odds of unplanned reintubation when compared with patients who were White. Further research should investigate the relationship between multiple variables including race, low socioeconomic status, and language barriers on surgical outcomes following pediatric orthopaedic procedures.
Level III-retrospective cohort analysis.
小儿发育性髋关节发育不良可通过保守或手术治疗。了解患者的风险因素对于优化发育性髋关节发育不良的手术治疗结果至关重要。种族差异对手术结果的影响已被研究，但关于种族与小儿矫形手术后并发症之间关联的文献却很少。我们的研究旨在通过调查 30 天术后并发症和住院时间，确定小儿患者种族与髋关节发育不良手术治疗结果之间的关系。
我们利用 2012 年至 2019 年国家手术质量改进计划-小儿数据库，确定所有接受手术治疗髋关节发育不良的小儿患者。将患者分为两组：白人患者和代表性不足的少数族裔（URM）患者。URM 组包括黑人或非裔美国人、西班牙裔、美国原住民或阿拉斯加原住民和夏威夷原住民或太平洋岛民。使用单变量和多变量分析比较两组患者的人口统计学、合并症和术后结局差异。
在 2012 年至 2019 年间接受髋关节发育不良手术治疗的 9159 例小儿患者中，6057 例（66.1%）为白人，3102 例（33.9%）为 URM 组。在单变量分析中，与白人患者相比，URM 组患者更有可能出现深部伤口裂开、肺炎、计划性再插管、心脏骤停和住院时间延长。多变量分析后，URM 组患者计划性再插管的风险增加（优势比：3.583；P=0.018）。
了解哪些患者因素影响手术结果，可使医疗保健团队更加了解高危患者群体。我们的研究发现，与白人患者相比，接受髋关节发育不良矫正手术的 URM 组小儿患者计划性再插管的可能性更高。进一步的研究应调查种族、低社会经济地位和语言障碍等多个变量与小儿矫形手术后手术结果之间的关系。
III 级-回顾性队列分析。
