Healthcare segregation in orthopedic surgery: A statewide analysis of American Indian and Alaska Native patients.
Alaska Native
American Indian
healthcare disparities
hip arthroplasty
knee arthroplasty
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
17 Oct 2023
17 Oct 2023
Historique:
revised:
06
10
2023
received:
21
07
2023
accepted:
16
10
2023
pubmed:
18
10
2023
medline:
18
10
2023
entrez:
18
10
2023
Statut:
aheadofprint
Résumé
Significant health disparities have been described for American Indian and Alaska Native (AIAN) patients undergoing various surgical procedures, however, research into healthcare segregation within orthopedic surgery has been limited. In this study, our purpose was to assess if AIAN patients were more likely to be treated by lower-volume surgeons and at lower-volume hospitals. AIAN and White patients who underwent one of four common orthopedic procedures (knee or hip arthroplasty, femur or tibia repair) were identified from a Washington state inpatient database. Demographic, socioeconomic, geographic, and procedure data were surveyed, and volumetric thresholds were established for lower versus higher volume surgeons and hospitals. Adjusted odds ratios were calculated for AIAN patients receiving care from a lower volume surgeon or hospital, including covariates for patient demographics, geographic, and socioeconomic status. AIAN patients were more likely to receive care from a lower-volume surgeon for all procedures except tibial repair. Adjusted odds ratios of 1.53 (95% confidence interval [CI]: 1.22, 1.92) and 1.68 (95% CI: 1.26, 2.21) were found for AIAN patients receiving knee or hip arthroplasty from a lower volume surgeon, respectively. There was no strong evidence of AIAN patients being more likely to receive care at a lower-volume hospital. Finally, AIAN patients having knee arthroplasty at a higher volume hospital were more likely to have their surgery performed by a lower volume surgeon. These data suggest that there may be significant healthcare segregation among AIAN patients across common orthopedic surgical procedures.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Orthopaedic Research Society.
Références
Amirian H, Torquati A, Omotosho P. Racial disparity in 30-day outcomes of metabolic and bariatric surgery. Obes Surg. 2020;30(3):1011-1020.
Erdrich J, Cordova-Marks F, Monetathchi AR, Wu M, White A, Melkonian S. Disparities in breast-conserving therapy for non-Hispanic American Indian/Alaska Native women compared with non-Hispanic White women. Ann Surg Oncol. 2022;29(2):1019-1030.
Gachupin FC, Lee BR, Chipollini J, et al. Renal cell carcinoma surgical treatment disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. Int J Environ Res Public Health. 2022;19(3):1185.
Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010-2011. Pediatrics. 2013;131(3):548-558.
Ottesen TD, Amick M, Kapadia A, et al. The unmet need for orthopaedic services among American Indian and Alaska Native communities in the United States. J Bone Jt Surg. 2022;104(11):e47.
Ferucci ED, Schumacher MC, Lanier AP, et al. Arthritis prevalence and associations in American Indian and Alaska Native people. Arthritis Care Res. 2008;59(8):1128-1136.
Ferucci ED, Templin DW, Lanier AP. Rheumatoid arthritis in American Indians and Alaska Natives: a review of the literature. Semin Arthritis Rheum. 2005;34(4):662-667.
Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop. 2011;2011:1-46.
Mauldin J, Cameron HD, Jeanotte D, Solomon G, Jarvis JN. Chronic arthritis in children and adolescents in two Indian health service user populations. BMC Musculoskelet Disord. 2004;5:30.
Agarwal-Harding KJ, Meara JG, Greenberg SLM, Hagander LE, Zurakowski D, Dyer GSM. Estimating the global incidence of femoral fracture from road traffic collisions: a literature review. J Bone Jt Surg. 2015;97(6):e31.
Agarwal-Harding KJ, von Keudell A, Zirkle LG, Meara JG, Dyer GSM. Understanding and addressing the global need for orthopaedic trauma care. J Bone Jt Surg. 2016;98(21):1844-1853.
Ezomo OT, Sun D, Gronbeck C, Harrington MA, Halawi MJ. Where do we stand today on racial and ethnic health disparities? An analysis of primary total hip arthroplasty from a 2011-2017 National Database. Arthroplast Today. 2020;6(4):872-876.
Rudisill SS, Varady NH, Birir A, Goodman SM, Parks ML, Amen TB. Racial and ethnic disparities in total joint arthroplasty care: a contemporary systematic review and meta-analysis. J Arthroplasty. 2023;38(1):171-187.e18.
Tse C, Grigorian A, Nahmias J, et al. Racial disparities in limb amputations after traumatic vascular injury. J Clin Orthop Trauma. 2019;10(suppl 1):S100-S105.
Zhang W, Lyman S, Boutin-Foster C, et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Jt Surg. 2016;98(15):1243-1252.
Vaughan Sarrazin MS, Campbell ME, Richardson KK, Rosenthal GE. Racial segregation and disparities in health care delivery: conceptual model and empirical assessment. Health Serv Res. 2009;44(4):1424-1444.
Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial disparities in outcomes after cardiac surgery: the role of hospital quality. Curr Cardiol Rep. 2015;17(5):29.
Wohlgemut JM, Ramsay G, Bekheit M, Scott NW, Watson AJM, Jansen JO. Emergency general surgery: impact of hospital and surgeon admission case volume on mortality. J Trauma Acute Care Surg. 2021;90(6):996-1002.
Goka EA, Phillips P, Poku E, et al. The relationship between hospital or surgeon volume and outcomes in lower limb vascular surgery in the United Kingdom and Europe. Ann Vasc Surg. 2017;45:271-286.
Becher RD, DeWane MP, Sukumar N, et al. Hospital operative volume and quality indication for general surgery operations performed emergently in geriatric patients. J Am Coll Surg. 2019;228(6):910-923.
Brodeur PG, Boduch A, Kim KW, Cohen EM, Gil JA, Cruz AI. Surgeon and facility volumes are associated with social disparities and post-operative complications after total hip arthroplasty. J Arthroplasty. 2022;37(8S):S908-S918.e1.
Yapp LZ, Walmsley PJ, Moran M, Clarke JV, Simpson AHRW, Scott CEH. The effect of hospital case volume on re-revision following revision total knee arthroplasty. Bone Joint J. 2021;103-B(4):602-609.
Farjoodi P, Skolasky RL, Riley LH. The effects of hospital and surgeon volume on postoperative complications after LumbarSpine surgery. Spine. 2011;36(24):2069-2075.
Weinheimer KT, Smuin DM, Dhawan A. Patient outcomes as a function of shoulder surgeon volume: a systematic review. Arthroscopy. 2017;33(7):1273-1281.
Deemer AR, Drake JH, Littlefield CP, Egol KA. Surgeon volume impacts outcomes following ankle fracture repair. Foot Ankle Orthop. 2022;7(3):247301142211167.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-1139.
Rangrass G, Ghaferi AA, Dimick JB. Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality. JAMA Surg. 2014;149(3):223-227.
Nolen LD, Bressler S, Vindigni SM, Miller K, Nash S. Gastric cancer in Alaska Native and American Indian people living in Alaska, 1990-2017. Clin Transl Gastroenterol. 2021;12(7):e00374.
Seipp R, Zhang N, Nair SS, et al. Patient and allograft outcomes after kidney transplant for the Indigenous patients in the United States. PLoS One. 2021;16(2):e0244492.
Schoenfeld AJ, Sandhu T, Sturgeon DJ, Nwosu K, Bono CM. Examining healthcare segregation among racial and ethnic minorities receiving spine surgical procedures in the state of Florida. Spine. 2017;42(24):1917-1922.
Jackson DK, Li Y, Eskander MF, et al. Racial disparities in low-value surgical care and time to surgery in high-volume hospitals. J Surg Oncol. 2021;123(2):676-686.
Haider AH, Scott VK, Rehman KA, et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg. 2013;216(3):482-492.
Schoenfeld AJ, Belmont PJ, See AA, Bader JO, Bono CM. Patient demographics, insurance status, race, and ethnicity as predictors of morbidity and mortality after spine trauma: a study using the National Trauma Data Bank. Spine J. 2013;13(12):1766-1773.
Knisely A, Huang Y, Melamed A, et al. Disparities in access to high-volume surgeons within high-volume hospitals for hysterectomy. Obstet Gynecol. 2021;138(2):208-217.
Liu C-J, Chou Y-J, Teng C-J, et al. Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: a nationwide population-based study. Cancer. 2015;121(16):2782-2790.