Omissions That Hurt: Do Patients with Missing Racial Data Have Higher OS-SSI Rates after Trauma Laparotomy?

Authors:
Stephanie Martinez Ugarte, Mokunfayo Fajemisin, William Rieger, Renee Walker, Parker Towns, Lillian Kao

Body of Abstract:
OBJECTIVE: While race/ethnicity is linked to outcomes disparities, limited information exists on outcomes, such as organ space surgical site infections (OS-SSIs), of patients with missing/unknown race. This study assesses if patients with missing race information had more OS-SSIs than those with reported race.

METHODS: A retrospective single-center study was performed of all trauma laparotomy patients (≥16 years) from 9/2019-6/2023. Data was obtained from the trauma registry and medical charts. Patients were divided based on whether their race/ethnicity was recorded as known or unknown during nursing intake. OS-SSIs were defined using the Centers for Disease Control and Prevention criteria. Univariate and multivariable analyses were performed.

RESULTS: Of 1110 included patients, the median age was 34 (IQR 25-47). Patients’ race/ethnicity was classified as White (280, 25%), Black (367, 33%), Hispanic (26, 2%), Asian (27, 2%), Other (339, 30%), and unknown (71, 6%). Patients of unknown race had a longer ICU length of stay (LOS) 2 (IQR 0-10) vs. 1(IQR 0-5) p=0.02, higher rates of OS-SSIs (21% vs 12%, p=0.018) and mortality (25% vs. 13%, p=0.005) compared to patients with a known race. On multivariable analysis, after controlling for large bowel resection, damage control laparotomy, injury severity score, and mechanism of injury, unknown race was associated with an increased odds of OS-SSI (OR 2, 1.1-4.0, p=0.03).

CONCLUSION: Patients of unknown race had more OS-SSIs than patients with a known race category. Accurate reporting of patients’ race is essential to obtaining precise and actionable insights into surgical outcomes and driving research and health policy.