O3239: Discrimination at the Ivory Tower: Does Time to Surgery for Urgent Fractures Vary Based on Race or Socioeconomic Status?

Background: Race and socioeconomic status are known to cause delays in care for patients with non-urgent orthopedic conditions, often attributed to systemic issues in healthcare delivery. Patients with urgent orthopedic issues, such as pediatric trauma, are assumed to receive equal care after presentation to a tertiary center, though this is understudied. Through utilizing a large, single-center retrospective database of pediatric elbow fractures, we examined if race or socioeconomic status altered the time from Emergency Department (ED) presentation to surgical treatment (OR) in children with Gartland type 3 supracondylar humerus fractures (SCHF). We hypothesize that there will be limited variation in time to surgery (EDOR time, < 10% change) secondary to gender, race, or socioeconomic status at our institution.

Methods: Following IRB approval, a retrospective chart review of patients treated at a single tertiary care center from 2007-2017 were reviewed. A pediatric orthopaedic surgeon confirmed diagnosis of Gartland extension type 3 SCHF. The presence of a neurovascular injury was also noted. Patient gender, race as recorded in the medical record, and Area Deprivation Index (ADI) based on home zip code were identified. ADI is defined as a ranking system of neighborhoods by socioeconomic disadvantage at both the state and national levels. It consists of categories, including income, education, and housing quality. Ranking is from 1 to 100 (1 indicates the lowest level of “disadvantage” nationally, and 100 indicates the highest “disadvantage”). Patients without complete data relevant to this study and/or those with multiple injuries were excluded. T-tests and ANOVA with multiple comparison corrections using the Bonferroni method were utilized to assess the effect of independent variables gender, race, and ADI on treatment time (ED presentationOR start).

Results: Across the study period, 775 patients with Gartland type 3 SCHF with complete demographic data were identified. Median age was 5.86 years, and 55% of patients were male. Race was categorized as White (n=559), Hispanic (n=109), African American (n=71), and Other, which included Pacific Islanders, Native Americans, and those who chose not to disclose (n=36). Patients presented from zip codes encompassing a range of ADI (7-95). No statistical difference was found for EDOR Time between groups on basis of gender, race, or ADI (Table 1). Subgroup analysis excluding patients with neurovascular compromise likewise revealed no differences.

Conclusion: Timing from presentation to surgery for Gartland type 3 SCHF at a larger tertiary care center was found to be similar among patients with different race, socioeconomic status, and gender. As anticipated, time to surgery was faster in patients with concomitant neurovascular injuries. Though implicit bias may affect other elements of patient care, surgical timing does not seem to be influenced by race or socioeconomic status in this particular setting.