S. Kartiko1, M. P. Forssten2,3, J. D. Forrester5, M. A. Ribeiro6,7, Y. Cao4, B. Sarani1, S. Mohseni2,3 5Stanford University, Surgery, Palo Alto, CA, USA 6Pontifical Catholic University of São Paulo, Surgery, Sao Paulo, Brazil 7Khalifa University and Gulf Medical University – Abu Dhabi, Surgery, Abu Dhabi, United Arab Emirates 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA 2Orebro University, School Of Medical Sciences, Orebro, Sweden 3Orebro University Hospital, Division Of Trauma & Emergency Surgery, Orebro, Sweden 4Orebro University, Clinical Epidemiology And Biostatistics, School Of Medical Sciences, Orebro, Sweden
Introduction:
The advances in medical technology have widened the gaps of healthcare outcomes exposing disparities is medical treatments. Surgical Stabilization for Rib Fractures (SSRF) as a treatment of rib fractures has been an increasingly popular procedure. The indication of SSRF, however is not yet firm. Some surgeons used flail chest as an indication, and some include multiple rib displaced rib fractures as an indication. Whenever equipoise remains, surgeons tend to pick and choose the patients to be operated, which may in turn uncover their unconscious bias despite their best intents. We hypothesized that there is a disparity in the procedure being performed based on the patients’ race.
Methods:
Data was obtained from The American College of Surgeons 2013-2021 Trauma Quality Improvement Program (TQIP) database. The study participants were divided into groups based on race according to TQIP data registry. To assess the association between race and SSRF, a Poisson regression model with robust standard errors was utilized.
Results:
Black patients were more often treated at a Level 1 Trauma Center (74%) compared to the other cohorts (p <0.001). Flail chest was most common in White (3.2%) and American Indians (3.4%) patients compared to Black (2.8%), Asian (2.7%), and Pacific Islanders (2.9%) (p = 0.012). After adjusting for potential confounding in the Poisson regression analyses, Black patients were found to be 26% less likely to undergo SSRF [adjusted IRR (95% CI): 0.74 (0.64-0.85), p <0.001] and Asian patients were 40% less likely to undergo SSRF [adjusted IRR (95% CI): 0.60 (0.43-0.81), p = 0.001], compared to White patients.
Conclusion:
There is a disparity in the delivery of SSRF in patients with ribs injury. Blacks and Asian patients underwent SSRF half as frequently as White patients. This discrepancy in care is concerning in the delivery of patient care and should be remedied.