American Indian and Alaska Native Patients Undergoing Hip Fracture Surgery: A National Retrospective Cohort Study Between 2016 and 2022

Introduction: Racial and ethnic disparities have been reported in the treatment of hip fractures; however, American Indian and Alaska Native (AI/AN) patients are often excluded. No existing racial disparity studies have evaluated the management and outcomes of hip fractures among AI/AN patients. We aim to assess whether there are disparities in risk factors, management, and complications in the surgical treatment of hip fractures among AI/AN patients. Methods: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to analyze AI/AN and White patients undergoing surgical treatment of hip fractures between 2016 and 2022. Descriptive statistics, t -tests, chi-squared tests, and multiple regression models were used to assess differences in patient demographics, preoperative comorbidities, time to surgery (TTS), and postoperative complications. Results: AI/AN patients were significantly younger than White patients yet had higher rates of preoperative comorbidities (diabetes [ P < 0.001], smoking [ P < 0.001], dialysis [ P < 0.001], anemia [ P = 0.007], and delirium [ P < 0.001]). When controlling for patient characteristics, TTS and mortality were similar between AI/AN and White patients ( P = 0.31, P = 0.38, respectively). However, AI/AN patients had significantly more postoperative complications including stroke ( P = 0.04) and pneumonia ( P < 0.01), had a shorter length of stay (LOS) ( P < 0.001), and were less likely to be discharged to a facility ( P < 0.001). Discussion: AI/AN patients with hip fractures had a higher burden of preoperative comorbidities and postoperative complications when compared with White patients. Reassuringly, AI/AN and White patients had similar TTS and 30-day mortality. When controlling for patient characteristics, AI/AN patients had a shorter LOS and were more likely to be discharged home. This may be inferred as a lack of access to rehabilitation facilities on discharge or more support from patient families and communities at home. Overall, AI/AN patients should be included in current and future research to better assess disparities in orthopaedic care.