Surgical stabilization of rib fractures-Does race matter?

Authors

Susan Kartiko, Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: skartiko@mfa.gwu.edu.
Maximilian Peter Forssten, School of Medical Sciences, Orebro University, Sweden; Department of Orthopedic Surgery, Orebro University Hospital, Sweden.
Marcelo A. Ribeiro, Pontifical Catholic University of São Paulo, Brazil; Department of Surgery, Khalifa University and Gulf Medical University, Abu Dhabi, UAE; Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE.
Yang Cao, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Sweden.
Babak Sarani, Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
Shahin Mohseni, School of Medical Sciences, Orebro University, Sweden; Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE.

Document Type

Journal Article

Publication Date

9-17-2024

Journal

Surgery

DOI

10.1016/j.surg.2024.08.009

Abstract

BACKGROUND: Advances in medical technology have widened the gaps and exposed disparities in medical treatments. The prevalence of surgical stabilization for rib fractures is rising despite its controversial indications for this treatment modality. In situations of equipoise, surgeons may find themselves choosing patients for surgery, revealing potential implicit biases. We hypothesize that there exists an inequity in surgical stabilization for rib fractures performed based on race. METHODS: Data were obtained from the American College of Surgeons 2013-2021 Trauma Quality Improvement Program database. Study participants were divided into race groups according to Trauma Quality Improvement Program data registry. To assess the association between race and surgical stabilization for rib fractures, a Poisson regression model was used. Potential confounding adjusted include race, age, sex, highest abbreviated injury severity score in each region, flail chest, sternum fracture, pneumothorax, hemothorax, pulmonary contusion, and comorbidities. RESULT: Black patients were more often treated at a level 1 trauma center (74%) (P < .001). Flail chest was most common in White (3.2%) and American Indian (3.4%) patients compared with other races (P = .012). After adjusting for potential confounding in the Poisson regression analyses, Black patients were 26% less likely to undergo surgical stabilization for rib fractures (adjusted incident rate ratio [95% confidence interval]: 0.74 [0.64-0.85], P < .001) and Asian were 40% less likely to undergo surgical stabilization for rib fractures (adjusted incident rate ratio [95% confidence interval]: 0.60 [0.43-0.81], P = .001) than White patients. CONCLUSION: There is a disparity in the delivery of surgical stabilization for rib fractures in patients with rib fractures. Black and Asian patients undergo surgical stabilization for rib fractures at a significantly lower rate than their White counterparts. This discrepancy in the delivery of care is concerning and requires further study.

APA Citation

Kartiko, Susan; Forssten, Maximilian Peter; Ribeiro, Marcelo A.; Cao, Yang; Sarani, Babak; and Mohseni, Shahin, "Surgical stabilization of rib fractures-Does race matter?" (2024). GW Authored Works. Paper 5629.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5629

Department

Surgery