From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Acad Orthop Surg. 2024 Nov 1;32(21):e1121-e1129. doi: 10.5435/JAAOS-D-23-01136. Epub 2024 Jul 9.
Delay in surgical management for orthopaedic emergencies and severe fracture types can result in notable morbidity and even mortality for patients. Disparities in various facets of orthopaedic care have been identified based on race/ethnicity, socioeconomic status, and payer status, but disparities in time to surgery have been poorly explored. The purpose of this study was, therefore, to investigate whether disparities exist in time to emergent orthopaedic surgery.
Patients who underwent surgery for hip fracture, femur fracture, pelvic fracture, septic knee, septic hip, or cauda equina syndrome over 2012 to 2020 were identified using national data. Multivariable linear regression models were constructed, controlling for age, sex, race/ethnicity, payer status, socioeconomic status, hospital setting, and comorbidities to examine the effect of payer status and race/ethnicity, on time to surgery.
Over 2012 to 2020, 247,370 patients underwent surgery for hip fracture, 64,827 for femur fracture, 14,130 for pelvic fracture, 14,979 for septic knee, 3,205 for septic hip, and 4,730 for cauda equina syndrome. On multivariable analysis, patients with Medicaid experienced significantly longer time to surgery for hip fracture, femur fracture, pelvic fracture, septic knee, and cauda equina syndrome ( P < 0.05 all). Black patients experienced longer time to surgery for hip fracture, femur fracture, septic knee, septic hip, and cauda equina syndrome, and Hispanic patients experienced longer time to surgery for hip fracture, femur fracture, pelvic fracture, and cauda equina syndrome ( P < 0.05 all).
The results of this study demonstrate that Medicaid-insured patients, and often minority patients, experience longer delays to surgery than privately insured and White patients. Future work should endeavor to identify causes of these disparities to promote creation of policies aimed at improving timely access to care for Medicaid-insured and minority patients.
III.
骨科急症和严重骨折类型的手术治疗延误会导致患者出现明显的发病率，甚至死亡率。基于种族/民族、社会经济地位和支付者身份，已经确定了骨科护理各个方面的差异，但手术时间的差异尚未得到充分探索。因此，本研究的目的是调查在紧急骨科手术中是否存在差异。
使用国家数据，确定了 2012 年至 2020 年间接受髋关节骨折、股骨骨折、骨盆骨折、感染性膝关节、感染性髋关节或马尾综合征手术的患者。构建多变量线性回归模型，控制年龄、性别、种族/民族、支付者身份、社会经济地位、医院设置和合并症，以检查支付者身份和种族/民族对手术时间的影响。
2012 年至 2020 年间，247370 例患者接受髋关节骨折手术，64827 例接受股骨骨折手术，14130 例接受骨盆骨折手术，14979 例接受感染性膝关节手术，3205 例接受感染性髋关节手术，4730 例接受马尾综合征手术。多变量分析显示，接受医疗补助的患者髋关节骨折、股骨骨折、骨盆骨折、感染性膝关节和马尾综合征的手术时间明显延长（均 P < 0.05）。黑人和西班牙裔患者的髋关节骨折、股骨骨折、感染性膝关节、感染性髋关节和马尾综合征的手术时间也较长（均 P < 0.05）。
本研究结果表明，医疗补助保险患者和少数民族患者通常比私人保险和白人患者手术时间更长。未来的工作应努力确定这些差异的原因，以促进制定旨在改善医疗补助保险和少数民族患者及时获得护理的政策。
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