Racial Disparities Exist in 90-Day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery.
Date
2024-07
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Abstract
Objectives
Racial disparities in healthcare outcomes exist, including in orthopaedic trauma care. The aim of this study was to determine the impact of race, social deprivation, and payor status on 90-day emergency department (ED) revisits among orthopaedic trauma surgery patients at a Level 1 trauma academic medical center.Methods
Design
Retrospective chart review analysis.Setting
Level 1 trauma academic center in Durham, NC.Patient selection criteria
Adult patients undergoing orthopaedic trauma surgery between 2017 and 2021.Outcome measures and comparisons
The primary outcome of this retrospective cohort study was 90-day return to the ED. Logistic regression analysis was performed for variables of interest [race, social deprivation (measured by the Area Deprivation Index), and payor status] separately and combined, with each model adjusting for distance to the hospital. Results were interpreted as odds ratios (ORs) of 90-day ED revisits comparing levels of the respective variables. Statistical significance was assessed at α = 0.05.Results
A total of 3120 adult patients who underwent orthopaedic trauma surgery between 2017 and 2021 were included in the analysis. Black race (OR = 1.47; 95% confidence interval [CI]: 1.17-1.84, P < 0.001) and Medicaid coverage (OR = 1.63, 95% CI: 1.20-2.21, P = 0.002) were significantly associated with higher odds of return to ED compared with non-Black or non-Medicaid-covered patients. While ethnic minority (Hispanic/Latino or non-White) was statistically significant while adjusting only for distance to the hospital (OR = 1.23, 95% CI: 1.00-1.50, P = 0.047), it was no longer significant after adjusting for the other sociodemographic variables (OR = 1.13, 95% CI: 0.91-1.39, P = 0.27). The weighted Area Deprivation Index was not associated with a difference in odds of return to ED in any adjusted models.Conclusions
The results highlight the presence of racial and socioeconomic disparities in ED utilization, with Black race and Medicaid coverage significantly associated with higher odds of return to the ED. Future research should delve deeper into comprehending the root causes contributing to these racial and socioeconomic utilization disparities and evaluate the effectiveness of targeted interventions to reduce them.Level of evidence
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.Type
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Publication Info
Pean, Christian, Tristan Chari, Bruno Valan, Emily Peairs, Emily Poehlein, Cynthia L Green, Erica Taylor, Alison Toth, et al. (2024). Racial Disparities Exist in 90-Day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery. Journal of orthopaedic trauma, 38(7). pp. 397–402. 10.1097/bot.0000000000002820 Retrieved from https://hdl.handle.net/10161/34848.
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Scholars@Duke
Christian Pean
Dr. Christian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine, where he serves as Executive Director of AI & IT Innovation. He also holds a secondary appointment as core faculty at the Duke‑Margolis Institute for Health Policy. An orthopaedic trauma surgeon, Dr. Péan’s clinical expertise spans fracture care and arthroplasty for fracture care, with a focus on shoulder procedures, total hip replacement for fracture and post‑traumatic hip arthritis, and the management of complex traumatic conditions including proximal humerus fractures, humerus nonunion, periprosthetic fracture fixation, and pelvis/acetabulum reconstruction.
Dr. Péan’s research addresses critical issues in orthopaedic surgery and health policy, with over 80 peer‑reviewed publications across artificial intelligence, public health, ethics, and surgical technique in orthopaedic trauma. His work leverages AI, data science, policy design, and clinical care transformation to address population health and value-based care in musculoskeletal care. A central thread of his scholarship integrates machine learning and large language models into risk prediction and care coordination to improve surgical outcomes. He has led system‑level efforts to screen for social drivers of health and coordinate resources for patients facing housing instability, transportation barriers, and food insecurity. He also develops and implements LLM‑based technologies that improve clinician workflow, and enhance patient engagement—core elements of population health focused, value‑based specialty care. Dr. Péan is active in policy advocacy and population health, with interests in specialty care alternative payment models.
A physician‑innovator, Dr. Péan is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value‑based care in musculoskeletal health with conversational AI. Built by clinicians and policy experts, RevelAi Health is designed to improve patient outcomes while combating clinician burnout through AI‑enabled care coordination.
Cynthia Lea Green
Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods
Erica Dianne Taylor
Dr. Erica Taylor, MD, MBA, is a practicing orthopaedic surgeon and senior healthcare leader whose career spans clinical practice, academic medicine, entrepreneurship, and national thought leadership. She is widely recognized for advancing healthcare transformation through innovative strategies that integrate quality, equity, leadership development, and system redesign. As the founder of national initiatives and organizations, she bridges frontline clinical expertise with enterprise strategy, preparing healthcare systems, medical technology companies, and professional societies to thrive in a changing landscape.
Alison Patricia Toth
Dr. Toth specializes in sports medicine with a focus on anterior cruciate ligament (ACL) and multi-ligament knee reconstruction, knee and shoulder arthroscopy, shoulder impingement and instability, rotator cuff tears, articular cartilage healing and repair; meniscus healing and repair; patella dislocation, and cell and molecular biology approaches to the treatment of musculoskeletal injuries.
Steven Arthur Olson
As an Orthopedic Surgeon my primary focus of research is joint preservation. My primary clinical interests are Orthopedic Trauma and Hip Reconstruction.
In Orthopedic Trauma my research interests are 1) Basic science investigations of articular fractures with two current animal models in use. 2) Clinical research includes evaluation of techniques to reduce and stabilize articular fractures, as well as management of open fractures.
In the area of Hip Reconstruction my areas of research are 1) Hip Arthroscopy and treatment of hip disorders, and treatment of labral tears in the treatment of hip pain. 2) Periacetabular osteotomy for the treatment of hip dysplasia.
Malcolm R DeBaun
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