Race or Ethnicity on Short Term Outcomes Following Ankle Open Reduction and Internal Fixation

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Racial and ethnic disparities have been well reported in the treatment and outcomes following procedures for traumatic orthopaedic injuries. Currently, there is limited reporting on the effect of race and ethnicity on the effect of outcomes following ankle fracture open reduction and internal fixation (ORIF). As such, this study aims to investigate racial and ethnic disparities in outcomes following ankle fracture ORIF. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2011-2019 to identify 31,885 patients undergoing ankle fracture ORIF. Patients were stratified into groups based on race or ethnicity with 23,432 (73.5%) of patients being white, 4,265 (13.4%) black or African American, and 4,188 (13.1%) Hispanic. Demographics, hospital length of stay (LOS), and 30-day complication, surgical site infection (SSI), Clavien-Dindo grade IV (CDIV) complication, readmission, reoperation, and mortality rates were compared between groups. The cohort was predominantly female (59.9%) and the mean age was 50.2 (range, 18-89) years. Results: Demographically, white patients were statistically significantly older (White=52.4, Black=44.42, Hispanic=42.42) and more female (White=61.5%, Black=58.9%, Hispanic=52.2%), while black patients had significantly higher BMI (White=31.2, Black=32.3, Hispanic=31.3) and were significantly more likely to be actively smoking (White=23.5%, Black=33.1%, Hispanic=18.8%). When controlling for differences in race and ethnicity, there was no statistically significant difference in risk of adverse outcome, with the exception of adverse discharge in which Hispanic patients had a statistically significantly decreased risk (OR=0.667; 95%CI=0.572-0.779). Conclusion: It is vital that physicians and surgeons alike identify opportunities to better care for patients, one such area of concern is patients of minority race or ethnicity. Despite the findings of other areas of orthopaedic surgery, we report no difference in rates of adverse outcomes when stratifying a nationally representative cohort by race or ethnicity.