From the Department of Orthopaedic Surgery; Washington University School of Medicine, St. Louis, MO.
J Am Acad Orthop Surg Glob Res Rev. 2022 Jul 29;6(7). doi: 10.5435/JAAOSGlobal-D-22-00126. eCollection 2022 Jul 1.
Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures.
The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment.
State databases identified 130,006 forearm (1575 open) and 51,979 tibial fractures (1339 open). Surgical treatment was done in 2.6% of closed and 37.5% of open forearm fractures and 7.9% of closed and 60.5% of open tibial fractures. A national estimated total of 3,312,807 closed and 46,569 open forearm fractures were included, 59,024 (1.8%) of which were treated surgically. A total of 719,374 closed and 26,144 open tibial fractures were identified; 52,506 (7.0%) were treated surgically. Multivariable regression revealed that race and/or insurance status were independent predictors for the lower likelihood of surgery in 3 of 4 groups: Black patients were 43% and 35% less likely to have surgery after closed and open forearm fractures, respectively, and patients with Medicaid were less often treated surgically for open tibial fractures in state (17%) and nationwide (20%) databases.
Disparities in pediatric forearm and tibial fracture care persist, especially for Black patients and those with Medicaid; identification of influencing factors and interventions to address them are important in improving equality and value of care.
尽管人们越来越关注医疗保健差异和改善不平等的干预措施，但仍需要进一步确定差异，特别是在儿科人群中。我们使用州和全国数据库来确定与小儿前臂和胫骨骨折手术治疗相关的因素。
使用美国四个州的医疗保健成本和利用项目州住院、急诊和门诊手术和服务数据库以及全国急诊数据库，使用国际疾病分类代码对 2006 年至 2015 年的患者进行了查询。多变量回归模型用于确定与手术治疗相关的因素。
州数据库确定了 130,006 例前臂（1575 例开放性）和 51,979 例胫骨骨折（1339 例开放性）。闭合性和开放性前臂骨折中分别有 2.6%和 37.5%接受了手术治疗，闭合性和开放性胫骨骨折中分别有 7.9%和 60.5%接受了手术治疗。全国共纳入 3,312,807 例闭合性和 46,569 例开放性前臂骨折，其中 59,024 例（1.8%）接受了手术治疗。共确定了 719,374 例闭合性和 26,144 例开放性胫骨骨折，其中 52,506 例（7.0%）接受了手术治疗。多变量回归显示，种族和/或保险状况是 4 组中 3 组手术可能性降低的独立预测因素：黑人患者闭合性和开放性前臂骨折后手术的可能性分别降低 43%和 35%，而州（17%）和全国（20%）数据库中 Medicaid 患者胫骨开放性骨折手术治疗的可能性较低。
小儿前臂和胫骨骨折治疗方面的差异仍然存在，特别是对于黑人患者和 Medicaid 患者；确定影响因素并采取干预措施对于提高护理平等和价值非常重要。
