Age, gender, and race influence treatment decisions for calcaneus fracture

A variety of socio-demographic variables – including residing in a lower-income zip code and lacking private insurance – can influence treatment decisions for orthopedic trauma patients, according to a new study on the management of calcaneus fractures.

“While our study demonstrated socio-demographic disparities regarding utilization of open reduction and internal fixation of calcaneus fractures, the exact reasons for these disparities remain unclear,” wrote Boris A. Zelle, MD, of UT Health San Antonio and his coauthors. The study was published in the Journal of Orthopaedic Surgery and Research.

To assess how certain variables might impact how patients manage decisions regarding orthopedic trauma surgery, the researchers identified 17,156 patients with closed calcaneus fractures via the National Inpatient Sample (NIS) and analyzed their treatment and demographic data. The statistical analysis included variables such as age, sex, insurance status, race/ethnicity, income, hospital location, and hospital size. A total of 59% of the patients (n = 10,117) underwent nonoperative management of their calcaneus fracture while 41% (n = 7,039) underwent open reduction and internal fixation. A multivariate logistic regression determined that variables like older age, female gender, being on Medicare, being African American or Hispanic, and having a lower estimated income by zip code were all associated with significantly lower use of surgical treatment (P less than .05). Not surprisingly, clinical comorbidities that were also associated with lower surgical rates included diabetes, peripheral vascular disease, a history of drug and alcohol abuse, and psychosis (P less than .05).

The authors acknowledged their study’s potential limitations, including a lack of research data on why these patients and providers chose surgery or otherwise. In addition, all available patient data came from a multicenter database, which can come with data entry issues. Finally, relying on data from only inpatient admissions “introduces a potential selection bias” by overrepresenting patients with “potentially more comorbidities and social issues.”

One author reported receiving consultant fees, speaker fees, and grant support from several organizations and medical corporations. The other authors reported no potential conflicts of interest.

SOURCE: Zelle BA et al. J Orthop Surg Res. 2019 Nov 12. doi: 10.1186/s13018-019-1402-8.

A variety of socio-demographic variables – including residing in a lower-income zip code and lacking private insurance – can influence treatment decisions for orthopedic trauma patients, according to a new study on the management of calcaneus fractures.

“While our study demonstrated socio-demographic disparities regarding utilization of open reduction and internal fixation of calcaneus fractures, the exact reasons for these disparities remain unclear,” wrote Boris A. Zelle, MD, of UT Health San Antonio and his coauthors. The study was published in the Journal of Orthopaedic Surgery and Research.

To assess how certain variables might impact how patients manage decisions regarding orthopedic trauma surgery, the researchers identified 17,156 patients with closed calcaneus fractures via the National Inpatient Sample (NIS) and analyzed their treatment and demographic data. The statistical analysis included variables such as age, sex, insurance status, race/ethnicity, income, hospital location, and hospital size. A total of 59% of the patients (n = 10,117) underwent nonoperative management of their calcaneus fracture while 41% (n = 7,039) underwent open reduction and internal fixation. A multivariate logistic regression determined that variables like older age, female gender, being on Medicare, being African American or Hispanic, and having a lower estimated income by zip code were all associated with significantly lower use of surgical treatment (P less than .05). Not surprisingly, clinical comorbidities that were also associated with lower surgical rates included diabetes, peripheral vascular disease, a history of drug and alcohol abuse, and psychosis (P less than .05).

The authors acknowledged their study’s potential limitations, including a lack of research data on why these patients and providers chose surgery or otherwise. In addition, all available patient data came from a multicenter database, which can come with data entry issues. Finally, relying on data from only inpatient admissions “introduces a potential selection bias” by overrepresenting patients with “potentially more comorbidities and social issues.”

One author reported receiving consultant fees, speaker fees, and grant support from several organizations and medical corporations. The other authors reported no potential conflicts of interest.

SOURCE: Zelle BA et al. J Orthop Surg Res. 2019 Nov 12. doi: 10.1186/s13018-019-1402-8.

A variety of socio-demographic variables – including residing in a lower-income zip code and lacking private insurance – can influence treatment decisions for orthopedic trauma patients, according to a new study on the management of calcaneus fractures.

“While our study demonstrated socio-demographic disparities regarding utilization of open reduction and internal fixation of calcaneus fractures, the exact reasons for these disparities remain unclear,” wrote Boris A. Zelle, MD, of UT Health San Antonio and his coauthors. The study was published in the Journal of Orthopaedic Surgery and Research.

To assess how certain variables might impact how patients manage decisions regarding orthopedic trauma surgery, the researchers identified 17,156 patients with closed calcaneus fractures via the National Inpatient Sample (NIS) and analyzed their treatment and demographic data. The statistical analysis included variables such as age, sex, insurance status, race/ethnicity, income, hospital location, and hospital size. A total of 59% of the patients (n = 10,117) underwent nonoperative management of their calcaneus fracture while 41% (n = 7,039) underwent open reduction and internal fixation. A multivariate logistic regression determined that variables like older age, female gender, being on Medicare, being African American or Hispanic, and having a lower estimated income by zip code were all associated with significantly lower use of surgical treatment (P less than .05). Not surprisingly, clinical comorbidities that were also associated with lower surgical rates included diabetes, peripheral vascular disease, a history of drug and alcohol abuse, and psychosis (P less than .05).

The authors acknowledged their study’s potential limitations, including a lack of research data on why these patients and providers chose surgery or otherwise. In addition, all available patient data came from a multicenter database, which can come with data entry issues. Finally, relying on data from only inpatient admissions “introduces a potential selection bias” by overrepresenting patients with “potentially more comorbidities and social issues.”

One author reported receiving consultant fees, speaker fees, and grant support from several organizations and medical corporations. The other authors reported no potential conflicts of interest.

SOURCE: Zelle BA et al. J Orthop Surg Res. 2019 Nov 12. doi: 10.1186/s13018-019-1402-8.