S. J. Skube1, B. Lindgren1, Y. J. Fan1, S. Jarosek1, G. B. Melton1, M. D. McGonigal1,2, M. R. Kwaan1 1University Of Minnesota,Minneapolis, MN, USA 2Regions Hospital,St. Paul, MN, USA
Introduction:
The colon is the second most commonly injured organ in patients sustaining penetrating abdominal trauma. The standard of care for colon injury has evolved from repair with fecal diversion to primary anastomosis or primary repair. Previous studies have demonstrated a ten-fold higher rate of penetrating abdominal trauma in African American men. Racial disparities have been both published and disputed in trauma patient mortality, functional outcomes, and rehabilitation. The aim of this project was to assess racial disparities in the surgical care of trauma patients with penetrating colon trauma by evaluating differences in stoma formation and post-operative outcomes.
Methods:
We identified men over the age of 14 in the National Trauma Data Bank between 2010-2014 who had operative intervention for colon trauma. Patients with rectal injury and those transferred to another facility were excluded. The primary outcome was stoma formation with secondary outcomes including post-operative morbidity and mortality. A multivariate logistic regression was performed for ostomy formation controlling for race and significant co-variates.
Results:
Our query resulted in identification of 7,324 men with penetrating colon trauma requiring operative intervention (4916 African American, 2408 Caucasian). 18.5% of Caucasian patients and 19.6% of African American patients underwent fecal diversion with stoma formation (p = 0.283). African American patients were younger with a median age of 27 (range 15-86) versus 35 (range 15-88), more likely to self-pay (37.1% versus 29.9%), and more likely to be injured by firearm (88.3% versus 70.2%). African American patients had less overall post-operative morbidity (50.7% versus 63.0%, p = <0.001). On multivariate analysis, the odds of receiving an ostomy for African American vs Caucasian patients was similar (odds ratio=0.95, 95% CI: 0.83-1.10). Factors associated with stoma formation in penetrating colon trauma are shown in Table 1.
Conclusion:
This analysis did not demonstrate a difference in stoma formation between African American and Caucasian men. Multivariate analysis confirmed expected findings that trauma severity (firearm, GCS, ISS) increased the odds of receiving ostomy. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to these disparities demonstrated in other healthcare settings.
