Racial disparities in early adverse events and unplanned readmission after open fixation of fractures distal to the knee

Objectives: To determine whether (1) early postoperative complications and (2) time to surgery for operative fixation of fractures distal to the knee differ for Black versus White patients and to assess whether disparities exist within fracture subtypes. Design: Retrospective database review. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. Patients/Participants: Patients (18 years or older) undergoing open fixation of fractures distal to the knee between 2010 and 2019 (n = 9172 patients). Intervention: Open reduction and internal fixation of fractures distal to the knee. Main Outcome Measurements: Thirty-day postoperative complications and time to surgery by race, as compared by multivariable regression with nearest-neighbor propensity score matching. Results: Of the 9172 patients in our cohort, 1120 (12%) were Black. After matching, we identified 1120 White patients with equal propensity scores as our Black patients. Black patients had 1.5 times higher odds (95% confidence interval [CI]: 1.0–2.0) of experiencing any early adverse event when compared with matched White counterparts. Black patients also had 1.9 times higher odds (95% CI: 1.2–3.0) of requiring unplanned readmission within 30 days of operative fixation. There were no significant differences by race in time to surgery. Fracture subtype (tibia/fibula shaft, isolated malleolar, bi/trimalleolar, and pilon fractures) was not associated with postoperative complications or time to surgery in the multivariable analysis. Conclusion: Racial disparities in the early postoperative course after open fixation of fractures distal to the knee exist, with significantly higher rates of early adverse events and unplanned readmission persist for Black versus White patients after propensity matching. Level of Evidence: Prognostic level III.