Rudisill Samuel S, Hornung Alexander L, Varady Nathan H, Pean Christian A, Lane Joseph M, Amen Troy B
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Rush Medical College, Rush University, Chicago, IL, USA.
HSS J. 2024 Nov;20(4):470-481. doi: 10.1177/15563316231199493. Epub 2023 Oct 11.
Hip fractures are common injuries that result in substantial loss of quality of life to elderly patients. To date, no meta-analyses have been performed to consolidate findings related to racial and ethnic disparities in hip fracture care.
We sought to examine associations between racial or ethnic identity and several metrics of hip fracture care.
For a systematic review and meta-analysis, we searched PubMed, Scopus, CINAHL, and SPORTDiscus databases in December 2021 for articles examining racial and ethnic disparities in hip fracture surgery among White, Black, Hispanic, Asian, Pacific Islander (PI), and American Indian/Alaska Native (AIAN) patients. Twenty-three studies reported time to surgery (TTS), complications, mortality, length of stay (LOS), discharge disposition, readmissions, or reoperations. Meta-analyses were conducted for outcomes for which there were at least 3 comparable studies with requisite data available.
Compared with White patients, Black patients experienced greater rates of TTS longer than 2 days, 30-day complication, 90-day readmission, 1-year reoperation, and longer LOS, though odds of 30-day mortality were reduced. Hispanic patients had higher 90-day complication rates and longer LOS but lower risk of mortality and nonhome discharge than other racial and ethnic groups. Time to surgery of longer than 2 days was more common among Asian patients, though mortality, nonhome discharge, and readmission rates were lower. There were higher mortality rates in White patients compared with Hispanic patients at all timepoints and compared with Black patients until 1 year following surgery, when rates were higher among Black patients.
This systematic review and meta-analysis found evidence of disparities in hip fracture surgery, with minority patients facing greater rates of surgical delay and perioperative complications. Even though the studies may not have been uniform in defining race or ethnicity or in accounting for the effects of systemic racism, these findings suggest that concerted efforts are needed to understand these gaps and promote equity in hip fracture care.
髋部骨折是常见损伤，会导致老年患者生活质量大幅下降。迄今为止，尚未进行荟萃分析来整合与髋部骨折护理中种族和民族差异相关的研究结果。
我们试图研究种族或民族身份与髋部骨折护理的几个指标之间的关联。
为进行系统评价和荟萃分析，我们于2021年12月在PubMed、Scopus、CINAHL和SPORTDiscus数据库中检索了研究白人、黑人、西班牙裔、亚裔、太平洋岛民（PI）和美国印第安人/阿拉斯加原住民（AIAN）患者髋部骨折手术中种族和民族差异的文章。23项研究报告了手术时间（TTS）、并发症、死亡率、住院时间（LOS）、出院处置、再入院或再次手术情况。对至少有3项具有必要可用数据的可比研究的结局进行了荟萃分析。
与白人患者相比，黑人患者手术时间超过2天、30天并发症、90天再入院、1年再次手术的发生率更高，住院时间更长，不过30天死亡率的几率有所降低。西班牙裔患者90天并发症发生率更高，住院时间更长，但与其他种族和民族群体相比，死亡率和非居家出院风险更低。手术时间超过2天在亚洲患者中更为常见，不过死亡率、非居家出院率和再入院率较低。在所有时间点，白人患者的死亡率均高于西班牙裔患者，在术后1年之前，白人患者的死亡率高于黑人患者，术后1年黑人患者的死亡率更高。
这项系统评价和荟萃分析发现了髋部骨折手术存在差异的证据，少数族裔患者面临更高的手术延迟率和围手术期并发症发生率。尽管这些研究在定义种族或民族或考虑系统性种族主义的影响方面可能并不统一，但这些发现表明需要共同努力来理解这些差距，并促进髋部骨折护理的公平性。
