No Disparity for American Indians in Surgery for Pelvis/Lower Extremity Fractures: a Cohort Study of the National Trauma Data Bank (NTDB).

Background: Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx).

Methods: Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses.

Results: AI/AN patients (2.7 %, n = 206) were younger (36 ± 16 versus 41 ± 18 years, p < 0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7 ± 25.3 versus 12.0 ± 22.5 h, respectively). Injury severity was predictive of surgery in all six models (OR = 0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (OR = 3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time.

Conclusion: The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx.