American Indian and Alaska Native Patients Undergoing Hip Fracture Surgery: A National Retrospective Cohort Study Between 2016 and 2022
- 1From the University of California (Grellinger, So, Keeley), San Francisco School of Medicine, San Francisco, CA, and the Department of Orthopaedic Surgery (Dr. Ward, Dr. Wong), University of California, San Francisco, CA.
Abstract
Introduction:: Racial and ethnic disparities have been reported in the treatment of hip fractures; however, American Indian and Alaska Native (AI/AN) patients are often excluded. No existing racial disparity studies have evaluated the management and outcomes of hip fractures among AI/AN patients. We aim to assess whether there are disparities in risk factors, management, and complications in the surgical treatment of hip fractures among AI/AN patients.
Methods:: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to analyze AI/AN and White patients undergoing surgical treatment of hip fractures between 2016 and 2022. Descriptive statistics, t-tests, chi-squared tests, and multiple regression models were used to assess differences in patient demographics, preoperative comorbidities, time to surgery (TTS), and postoperative complications.
Results:: AI/AN patients were significantly younger than White patients yet had higher rates of preoperative comorbidities (diabetes [P < 0.001], smoking [P < 0.001], dialysis [P < 0.001], anemia [P = 0.007], and delirium [P < 0.001]). When controlling for patient characteristics, TTS and mortality were similar between AI/AN and White patients (P = 0.31, P = 0.38, respectively). However, AI/AN patients had significantly more postoperative complications including stroke (P = 0.04) and pneumonia (P < 0.01), had a shorter length of stay (LOS) (P < 0.001), and were less likely to be discharged to a facility (P < 0.001).
Discussion:: AI/AN patients with hip fractures had a higher burden of preoperative comorbidities and postoperative complications when compared with White patients. Reassuringly, AI/AN and White patients had similar TTS and 30-day mortality. When controlling for patient characteristics, AI/AN patients had a shorter LOS and were more likely to be discharged home. This may be inferred as a lack of access to rehabilitation facilities on discharge or more support from patient families and communities at home. Overall, AI/AN patients should be included in current and future research to better assess disparities in orthopaedic care.
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BibTeX
@article{grellinger2026american,
title = {{American Indian and Alaska Native Patients Undergoing Hip Fracture Surgery: A National Retrospective Cohort Study Between 2016 and 2022}},
author = {Emma D. Grellinger and Alexandra So and Timothy Keeley and Derek Ward and Stephanie E. Wong},
journal = {Journal of the American Academy of Orthopaedic Surgeons. Global research \& reviews},
year = {2026},
month = nov,
doi = {10.5435/jaaosglobal-d-25-00185},
url = {https://europepmc.org/article/PMC/PMC13722505},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - American Indian and Alaska Native Patients Undergoing Hip Fracture Surgery: A National Retrospective Cohort Study Between 2016 and 2022
AU - Emma D. Grellinger
AU - Alexandra So
AU - Timothy Keeley
AU - Derek Ward
AU - Stephanie E. Wong
PY - 2026
DA - 2026/11/01
JO - Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
DO - 10.5435/jaaosglobal-d-25-00185
UR - https://europepmc.org/article/PMC/PMC13722505
AB - Introduction:: Racial and ethnic disparities have been reported in the treatment of hip fractures; however, American Indian and Alaska Native (AI/AN) patients are often excluded. No existing racial disparity studies have evaluated the management and outcomes of hip fractures among AI/AN patients. We aim to assess whether there are disparities in risk factors, management, and complications in the surgical treatment of hip fractures among AI/AN patients. Methods:: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to analyze AI/AN and White patients undergoing surgical treatment of hip fractures between 2016 and 2022. Descriptive statistics, t-tests, chi-squared tests, and multiple regression models were used to assess differences in patient demographics, preoperative comorbidities, time to surgery (TTS), and postoperative complications. Results:: AI/AN patients were significantly younger than White patients yet had higher rates of preoperative comorbidities (diabetes [P < 0.001], smoking [P < 0.001], dialysis [P < 0.001], anemia [P = 0.007], and delirium [P < 0.001]). When controlling for patient characteristics, TTS and mortality were similar between AI/AN and White patients (P = 0.31, P = 0.38, respectively). However, AI/AN patients had significantly more postoperative complications including stroke (P = 0.04) and pneumonia (P < 0.01), had a shorter length of stay (LOS) (P < 0.001), and were less likely to be discharged to a facility (P < 0.001). Discussion:: AI/AN patients with hip fractures had a higher burden of preoperative comorbidities and postoperative complications when compared with White patients. Reassuringly, AI/AN and White patients had similar TTS and 30-day mortality. When controlling for patient characteristics, AI/AN patients had a shorter LOS and were more likely to be discharged home. This may be inferred as a lack of access to rehabilitation facilities on discharge or more support from patient families and communities at home. Overall, AI/AN patients should be included in current and future research to better assess disparities in orthopaedic care.
SN - 2474-7661
ER -