Racial Equity in Facial Laceration Repair: Evaluating a Pediatric Plastic Surgery Consult Guideline

Facial lacerations are of particular concern to families due to the potential for adverse long-term cosmetic outcomes. Plastic surgery consultation may be requested for facial laceration repair at specialized centers, yet multiple factors may drive inequitable access to care. The objective of this study was to evaluate whether racial and ethnic inequities existed in plastic surgery consultation rates for facial laceration repair.

This was a retrospective cross-sectional study of facial laceration repairs between 2016 and 2022 at a single-center, urban quaternary care freestanding children's hospital. All patients aged 0-18 years who received a facial laceration repair in the pediatric emergency department were included. A clinical practice guideline for plastic surgery consultation was implemented in March 2020.

A total of 6,938 unique laceration encounters were included in the study. Unadjusted plastic surgery repair rates in the preguideline period were 8.5% (n=71 of 832) for Hispanic, 6.7% (n=31 of 462) for non-Hispanic Black, and 28.5% (n=639 of 2,241) for non-Hispanic White patients, and after guideline implementation, the rates were 5.9% (n=17 of 286) for Hispanic, 7.3% (n=9 of 124) for non-Hispanic Black, and 11.9% (n=103 of 867) for non-Hispanic White patients. Prior to the clinical practice guideline implementation, non-Hispanic Black patients had significantly lower odds of plastics repair than non-Hispanic White patients (AOR=0.18; 95% CI=0.11, 0.29). After clinical practice guideline implementation, no statistically significant difference was detected (AOR=0.63; 95% CI=0.30, 1.31).

Previously unrecognized health inequities in plastic surgery consultation rates existed prior to and statistically resolved after implementation of a consultation guideline for facial laceration repair. This study provides insight into the potential secondary benefits of guideline implementation to reduce health inequities, yet persistent differing rates of plastic surgery repair by race and ethnicity in the postguideline period underscore the limitations of sole reliance on standardized guidelines to address racial and ethnic inequities in care.