Healthcare disparities in trauma: why they exist and what we can do.

PURPOSE OF REVIEW: This review will explore the underlying causes of healthcare disparities among trauma patients and offer considerations for reducing inequities to improve trauma care. RECENT FINDINGS: Newly recognized racial disparities exist with respect to triaging trauma patients and in acute pain management. Social Determinants of Health offers a model to understand disparity in trauma care. SUMMARY: Race, ethnicity, socioeconomic status, and access to healthcare drive outcome disparity among trauma patients. These disparities include reduced healthcare services, inadequate pain management, reduced postdischarge care, and increased mortality. Increasing workforce diversity may mitigate implicit bias and improve cultural competency. Social determinants of health impact the disparities in trauma care and offer a framework to address care through creative solutions.

Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing?

Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. However, these tools are limited because data are obtained from specific patient populations, are simplified to aid ease of use, and do not account for improved treatment modalities that occur over time. Risk estimation allows for shared decision-making among the perioperative care team and the patient, for perioperative planning, and for opportunity for risk mitigation. Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.