L. M. Woldanski1, K. Haines1, T. Zens1, S. Agarwal1 1University Of Wisconsin School Of Medicine And Public Health,Department Of Surgery,Madison, WI, USA
Introduction: Racial, ethnic, and socioeconomic disparities exist in trauma patients. Management of blunt splenic injuries (BSI) can vary from splenectomy, embolization, or non-operative management. This study assessed the effect of race and insurance status on treatment plans and outcomes in blunt splenic trauma.
Methods: The National Trauma Data Bank was used to study on patients aged 15-89 with BSI from 2013-2015. Patients with abbreviated injury scores greater than 2 in non-abdominal areas were eliminated, as were patients with other concomitant abdominal injuries requiring repair. Variables of interest were compared across groups using Chi-Square tests, and those with significant associations were used in multivariate regression models for each outcome of interest to control for confounding variables.
Results:We analyzed 13,537 BSI patients. Uninsured patients had increased odds of mortality (OR 1.6, p>0.001), more splenic operations (OR 1.6, p<0.001), and were less likely to have non-operative management (OR 0.63, p<0.001). Uninsured patients were also twice as likely to be discharged home and three times as likely to leave AMA. (OR 0.35, OR 0.33; p<0.001). Blacks and Hispanics had higher mortality (OR 1.5; p=0.035, p=0.029 respectively). Blacks had more splenic operations (OR 1.23, p=0.03) and were 0.5 times less likely to receive angioembolization (p<0.001), while Hispanics had less splenic operations (OR 0.81, p=0.032).
Conclusion:Noteworthy differences exist in the management of splenic trauma patients based on race/ethnicity and socioeconomic status, despite controlling for demographics and injury characteristics. Insurance status and race affect surgical treatment plans and mortality, particularly for uninsured, Black and Hispanic patients.