Racial Disparities Exist in 90-day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery

Abstract

Introduction: Racial disparities in healthcare outcomes exist, including in orthopaedic trauma care. This study aimed to determine the impact of race, social deprivation, and payor status on 90-day emergency department (ED) revisits among orthopaedic trauma surgery patients at a Level 1 trauma academic medical center. Design: Retrospective Chart Review Analysis Level 1 Academic Trauma Center in Durham, North Carolina Adult Patients undergoing orthopaedic trauma surgery between 2017 and 2021 Outcome Measures and Comparisons: The primary outcome of this retrospective cohort study was 90-day return to the ED. Logistic regression analysis was performed for variables of interest [race, social deprivation (measured by Area Deprivation Index), and payor status] separately and combined, with each model adjusting for distance to the hospital. Results were interpreted as odds ratios (ORs) of 90-day ED revisits comparing levels of the respective variables. Statistical significance was assessed at α=0.05. A total of 3,120 adult patients who underwent orthopaedic trauma surgery between 2017 and 2021 were included in the analysis. Black race (OR=1.47; 95% CI: 1.17-1.84, p<0.001) and Medicaid coverage (OR=1.63, 95% CI: 1.20-2.21, p=0.002) were significantly associated with higher odds of return to ED compared to non-Black or non-Medicaid-covered patients. While ethnic minority (Hispanic/Latino or non-White) was statistically significant while adjusting only for distance to the hospital (OR=1.23, 95% CI: 1.00-1.50, p=0.047), it was no longer significant after adjusting for the other sociodemographic variables (OR=1.13, 95% CI: 0.91-1.39, p=0.27). Weighted Area Deprivation Index (ADI) was not associated with a difference in odds of return to ED in any adjusted models. The results highlight the presence of racial and socioeconomic disparities in ED utilization, with Black race and Medicaid coverage significantly associated with higher odds of return to the ED. Future research should delve deeper into comprehending the root causes contributing to these racial and socioeconomic utilization disparities and evaluate the effectiveness of targeted interventions to reduce them. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.