Thomas Q Xu1, Aaron L Wiegmann1, Taylor J Jarazcewski2, Ethan M Ritz3, Carlos A Q Santos3, Amir H Dorafshar2. 1. Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA. 2. Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA. 3. Bioinformatics and Biostatistics Core at Rush University, Rush University Medical Center, Chicago, IL, USA.
Abstract
INTRODUCTION: Health-care disparities have been reported throughout medical literature for decades. While blatant explicit bias is not prevalent, a substantial body of research has been published suggesting that systemic biases related to sex, race, income, and insurance status likely exist. To our knowledge, no study has assessed the impact of patient race and insurance status on clinical decision-making in facial fracture repair in the United States. Thus, the objective of this project was to assess if race and insurance status impacted whether patients obtained open or closed treatment of simple mandibular fractures. METHODS: Patients who had either open or closed treatment of mandibular fractures were extracted from the 2012 and 2013 National Inpatient Sample and analyzed. Patients who had a length of stay longer than 3 days or died during their inpatient stay were excluded. These exclusion criteria were used to control for patients with polytrauma as well as complicated fractures. Univariate analysis was undertaken to elucidate different variable associations with the type of reduction performed. All covariates were then entered into a multivariable logistic regression model to test the variables simultaneously. RESULTS: Patients with simple condylar, alveolar border, and closed mandibular fractures were more likely to undergo closed reduction (CR) on univariate analysis, as were patients with female gender and a fall mechanism (P value < .05). African Americans, Hispanics, and patients without insurance were more likely to undergo open reduction on univariate analysis (P value < .05). Multivariate analysis demonstrated that patients with simple condylar, subcondylar, alveolar border, or closed mandibular fractures were more likely to undergo a CR, as were patients with female gender and a firearm or fall mechanism (P < .05). However, neither race nor insurance status demonstrated a statistically significant association with closed or open reduction. CONCLUSION: Anatomic location and mechanism of injury were the variables found to be significantly associated with patients undergoing open reduction versus CR of simple mandibular fractures-not race or insurance status.
INTRODUCTION: Health-care disparities have been reported throughout medical literature for decades. While blatant explicit bias is not prevalent, a substantial body of research has been published suggesting that systemic biases related to sex, race, income, and insurance status likely exist. To our knowledge, no study has assessed the impact of patient race and insurance status on clinical decision-making in facial fracture repair in the United States. Thus, the objective of this project was to assess if race and insurance status impacted whether patients obtained open or closed treatment of simple mandibular fractures. METHODS: Patients who had either open or closed treatment of mandibular fractures were extracted from the 2012 and 2013 National Inpatient Sample and analyzed. Patients who had a length of stay longer than 3 days or died during their inpatient stay were excluded. These exclusion criteria were used to control for patients with polytrauma as well as complicated fractures. Univariate analysis was undertaken to elucidate different variable associations with the type of reduction performed. All covariates were then entered into a multivariable logistic regression model to test the variables simultaneously. RESULTS: Patients with simple condylar, alveolar border, and closed mandibular fractures were more likely to undergo closed reduction (CR) on univariate analysis, as were patients with female gender and a fall mechanism (P value < .05). African Americans, Hispanics, and patients without insurance were more likely to undergo open reduction on univariate analysis (P value < .05). Multivariate analysis demonstrated that patients with simple condylar, subcondylar, alveolar border, or closed mandibular fractures were more likely to undergo a CR, as were patients with female gender and a firearm or fall mechanism (P < .05). However, neither race nor insurance status demonstrated a statistically significant association with closed or open reduction. CONCLUSION: Anatomic location and mechanism of injury were the variables found to be significantly associated with patients undergoing open reduction versus CR of simple mandibular fractures-not race or insurance status.
Authors: Wendy R Greene; Tolulope A Oyetunji; Umar Bowers; Adil H Haider; Thomas A Mellman; Edward E Cornwell; Suryanarayana M Siram; David C Chang Journal: Am J Surg Date: 2010-04 Impact factor: 2.565
Authors: Pauline Bus; Mieke J Aarts; Valery E P P Lemmens; Martijn G van Oijen; Geert-Jan Creemers; Grard A Nieuwenhuijzen; Jantine W van Baal; Peter D Siersema Journal: J Clin Gastroenterol Date: 2012 Nov-Dec Impact factor: 3.062
Authors: Caitlin W Hicks; Zain G Hashmi; Catherine Velopulos; David T Efron; Eric B Schneider; Elliott R Haut; Edward E Cornwell; Adil H Haider Journal: JAMA Surg Date: 2014-07 Impact factor: 14.766