Healthcare Segregation in Orthopaedic Surgery: A Statewide Analysis of American Indian and Alaska Native Patients.

Significant health disparities have been described for American Indian and Alaska Native (AIAN) patients undergoing various surgical procedures, however research into healthcare segregation within orthopaedic surgery has been limited. In this study, our purpose was to assess if AIAN patients were more likely to be treated by lower volume surgeons and at lower volume hospitals. AIAN and White patients who underwent one of four common orthopaedic procedures (knee or hip arthroplasty, femur or tibia repair) were identified from a Washington State inpatient database. Demographic, socioeconomic, geographic, and procedure data were surveyed, and volumetric thresholds established for lower vs. higher volume surgeons and hospitals. Adjusted odds ratios were calculated for AIAN patients receiving care from a lower volume surgeon or hospital, including covariates for patient demographics, geographic, and socioeconomic-status. AIAN patients were more likely to receive care from a lower volume surgeon for all procedures except tibial repair. Adjusted odds ratios of 1.53 (95% CI 1.22, 1.92) and 1.68 (95% CI 1.26, 2.21) were found for AIAN patients receiving knee or hip arthroplasty from a lower volume surgeon, respectively. There was no strong evidence of AIAN patients being more likely to receive care at a lower volume hospital. Finally, AIAN patients having knee arthroplasty at a higher volume hospital were more likely to have their surgery performed by a lower volume surgeon. These data suggest that there may be significant healthcare segregation among AIAN patients across common orthopaedic surgical procedures. This article is protected by copyright. All rights reserved.