Do Disparities Exist in the Timing of Traumatic Nasal Repair?

BACKGROUND

Previous research has demonstrated disparities in access to care for patients with facial fractures. This study aimed to assess potential disparities in timing to nasal bone repositioning among hospitalized patients who received treatment.

METHODS

Data from the 2017-2022 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) and the International Classification of Diseases 10th revision codes (ICD-10) were used. The time to nasal bone repositioning was analyzed using multivariable Cox proportional hazards regression analysis.

RESULTS

We analyzed data from 14,815 adult patients with traumatic nasal bone fractures who underwent repositioning during their index hospitalization. Within ten days of the initial presentation, 95 % of the patients underwent nasal repositioning. Black (HR = 0.90; CI = 0.85-0.95) and Asian (HR = 0.80; CI = 0.70-0.93) race, older age, private insurance (HR = 0.95; CI = 0.91-0.99), high Injury Severity Scores (ISS) (ISS 25+: HR = 0.33; CI = 0.31-0.35), specific injury mechanisms, facial fractures, and certain comorbidities were associated with statistically significantly longer times to repositioning. Treatment at a Level II trauma center (HR = 1.11; CI = 1.06-1.15), interfacility transfers (HR = 1.12; CI = 1.08-1.16), and open facial wounds were linked to statistically significantly shorter times to intervention.

CONCLUSION

In this large ACS-TQIP sample, most patients who did undergo nasal bone repositioning received it within the standard of care, with only minor timing variations based on demographic and geographic factors. In cases with higher injury severity, life-threatening injuries were prioritized before addressing nasal bone fractures. Further research should investigate initial care-access inequities in patients who experienced facial trauma but did not receive comprehensive care.