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The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury.

Publication ,  Journal Article
Haines, KL; Woldanski, LM; Zens, T; Vatsaas, C; Alger, A; Brooks, K; Kasotakis, G; Agarwal, S
Published in: J Surg Res
August 2019

BACKGROUND: Racial, ethnic, and socioeconomic disparities have been shown to exist in trauma patients. Management of blunt splenic injuries (BSIs) can include splenectomy, embolization, or nonoperative management. This study assesses the effect of race and insurance status on outcomes in patients after blunt splenic trauma. METHODS: The National Trauma Data Bank was used to study patients aged 15-89 y with BSIs from 2013 to 2015. Patients with abbreviated injury scores greater than two in nonabdominal areas, excluding extremities, were eliminated, as were patients with other concomitant abdominal injuries requiring repair. Variables of interest were compared across groups using chi-square tests, and those with significant associations were used in multivariate regression models for each outcome. RESULTS: We analyzed 13,537 BSI patients. Uninsured patients had increased odds of mortality, more splenic operations, and were less likely to have nonoperative management (P < 0.001). Uninsured patients were also twice as likely to be discharged home and three times as likely to leave against medical advice (P < 0.001). African Americans and Hispanics had higher mortality (odds ratio [OR] 2.03, CI 1.34-3.08; OR 1.58, CI 1.03-2.44, respectively). African Americans had more splenic operations (OR 1.33, CI 1.08-1.64) and were 60% less likely to receive angioembolization (CI 0.41-0.84). Hispanics had fewer splenic operations (OR 0.79, CI 0.63-0.98). CONCLUSIONS: Noteworthy differences exist in the management of splenic trauma patients based on race/ethnicity and socioeconomic status, despite controlling for demographics and injury characteristics. Insurance status and race likely affect surgical treatment plans and mortality, particularly for uninsured, black, and Hispanic patients, but further research is needed to identify the root cause of these disparities.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

August 2019

Volume

240

Start / End Page

60 / 69

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • Treatment Outcome
  • Surgery
  • Splenectomy
  • Spleen
  • Social Class
  • Retrospective Studies
  • Patient Discharge
  • Middle Aged
 

Citation

APA
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Haines, K. L., Woldanski, L. M., Zens, T., Vatsaas, C., Alger, A., Brooks, K., … Agarwal, S. (2019). The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury. J Surg Res, 240, 60–69. https://doi.org/10.1016/j.jss.2019.02.040
Haines, Krista L., Lauren M. Woldanski, Tiffany Zens, Cory Vatsaas, Amy Alger, Kelli Brooks, George Kasotakis, and Suresh Agarwal. “The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury.J Surg Res 240 (August 2019): 60–69. https://doi.org/10.1016/j.jss.2019.02.040.
Haines KL, Woldanski LM, Zens T, Vatsaas C, Alger A, Brooks K, et al. The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury. J Surg Res. 2019 Aug;240:60–9.
Haines, Krista L., et al. “The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury.J Surg Res, vol. 240, Aug. 2019, pp. 60–69. Pubmed, doi:10.1016/j.jss.2019.02.040.
Haines KL, Woldanski LM, Zens T, Vatsaas C, Alger A, Brooks K, Kasotakis G, Agarwal S. The Impact of Race and Socioeconomic Status on Treatment and Outcomes of Blunt Splenic Injury. J Surg Res. 2019 Aug;240:60–69.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

August 2019

Volume

240

Start / End Page

60 / 69

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • Treatment Outcome
  • Surgery
  • Splenectomy
  • Spleen
  • Social Class
  • Retrospective Studies
  • Patient Discharge
  • Middle Aged