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Geographic Distribution of Orthopaedic Trauma Resources and Service Use in the United States: A Cross Sectional Analysis

  • Molly P. Jarman
    Correspondence
    Corresponding author. Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont St, STE 2-016, Boston, MA 02120, Tel: 1-617-525-9286; Fax: 1-617-525-7723
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts

    Department of Surgery, Harvard Medical School, Boston, Massachusetts
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  • Michael J. Weaver
    Affiliations
    Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts

    Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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  • Adil H. Haider
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts

    College of Medicine, Aga Khan University, Karachi, Pakistan
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  • Ali Salim
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts

    Department of Surgery, Harvard Medical School, Boston, Massachusetts

    Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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  • Mitchel B. Harris
    Affiliations
    Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts

    Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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      Abstract

      Background

      Management of orthopaedic injury is an essential component of comprehensive trauma care, and availability of orthopaedic surgeons impacts trauma system capacity and accessibility of care. We sought to estimate the geographic distribution of orthopaedic injury in the United States and identify regions needing additional orthopaedic trauma resources.

      Methods

      In this retrospective cross-sectional study using 2014 Agency for Healthcare Research and Quality State Inpatient Datasets from 26 states and the District of Columbia, administrative data were used to determine hospital referral region (HRR)-level incidence of orthopaedic trauma and surgical care. Factors associated with HRR-level orthopaedic trauma volume were identified using negative binomial regression, and model parameters were used to estimate injury incidence and operative volume in unobserved HRRs. The primary outcomes of interest were HRR-level incidence of orthopaedic injury, polytrauma, and emergency orthopaedic surgery, as well and the number of emergency orthopaedic surgery patients per orthopaedic surgeon.

      Results

      Orthopaedic injury incidence and operative patients per orthopaedic surgeon were associated with HRR-level volume of medical service use, population characteristics, geographic characteristics, and existing trauma care resources. Orthopaedic injury incidence ranged from 20 patients/HRR to 33,260 patients/HRR. Polytrauma incidence ranged from < 10 patients/HRR to 12,140 patients/HRR. Emergency orthopaedic surgery incidence ranged from < 10 patients/HRR to 18,759 patients/HRR. The volume of operative orthopaedic trauma patients per orthopaedic surgeon ranged from < 10 patients/surgeon to 224 patients and/or surgeon.

      Discussion

      The incidence of orthopaedic injury and volume of injury patients per orthopaedic surgeon varies substantially across HRRs in the United States. Regions with high patient volume and moderate patient-to-provider ratios may be ideal settings for orthopaedic trauma training programs or post-fellowship professional opportunities. Future research should examine the impact of high volume orthopaedic trauma volume and high patient-to-provider ratios on health outcomes.

      Keywords

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