Objectives: To determine if racial or economic disparities are associated with short term complications and outcomes in tibial plateau fracture care.
Design: Retrospective cohort study
Setting: All New York State hospital admissions from 2000 to 2014, as recorded by the New York Statewide Planning and Research Cooperative System database
Patients/Participants: Thirteen thousand five hundred eighteen inpatients with isolated tibial plateau fractures (AO/OTA 44), stratified in four groups: Caucasian, African-American, Hispanic, and Other.
Intervention: Closed treatment and operative fixation of the tibial plateau
Main Outcome Measurements: Hospital LOS (days), in-hospital complications/mortality, estimated total costs, and 30-day readmission
Results: There were no significant differences with regard to in-hospital mortality, infection, deep vein thrombosis/ pulmonary embolism (DVT/PE), or wound complications between races, even when controlling for income. There was a higher rate of non-operatively treated fractures in the racial minority populations. Minority patients had on average 2 days longer length of stay (LOS) compared to Caucasians (p<0.001), costing on average $4,000 more per hospitalization (p<0.001). Multivariate logistic regression found that neither race nor estimated median family income were independent risk factors for readmission.
Conclusions: While nature of initial injury, use of external fixator, comorbidity burden, age, insurance type and LOS were independent risk factors for readmission, race and estimated median family income were not. In patients who sustained a tibial plateau fracture, race and ethnicity seemed to affect treatment choice, but once treated racial minority groups did not demonstrate worse short term complications, including increased mortality and postoperative readmission rates.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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