Non-medical patient-related factor influence in proximal humeral fracture outcomes: a multicentric study

Miquel, Joan; Elisa, C.; Fernando, Santana; Alba, Romero; Torrens, Carlos

doi:10.1007/s00402-020-03643-9

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…15–17 Although medical and surgical management are important for care, recent evidence suggests that a person's socioeconomic factors impact outcomes and must be taken into account to optimize care. 7,8,13,18–20 The present study found that patients with educational deficiencies had increased rates of readmission and major complications compared with those without disparities following hip and ankle fracture management. Moreover, economic disparities were associated with an increased risk of readmission and revision following hip fixation and infection and readmission following ankle fracture surgery.…”

Section: Discussionmentioning

confidence: 49%

“…Previous literature has identified various factors of SDH associated with poor outcomes, such as race, insurance status, poor finances, and inadequate literacy, among others. 7,8,13,[18][19][20] Rubenstein et al 18 found that black race significantly negatively correlated with knee functional outcome when compared with white race following total joint arthroplasty. Education, gender, comorbidities, and neighborhood poverty were also found to be significantly associated with lower functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…21 Similarly, a multicentric study revealed that those who considered themselves economically self-sufficient had an increased likelihood of positive functional outcomes after proximal humeral fractures. 20 Although medical literature is inundated with associations of demographic characteristics and outcomes following surgery, this study focuses on a comprehensive analysis of diverse SDH disparities that further explores the impact of disparities in fracture care.…”

Section: Discussionmentioning

confidence: 99%

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National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

Kamalapathy

Dunne

Yarboro

2022

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

Kamalapathy

Dunne

Yarboro

2022

Journal of Orthopaedic Trauma

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“…Although previous literature has identified various social determinants of health such as race, insurance status, and financial status to be associated with poor outcomes 24,25 , identification of demographic variables in isolation may not adequately reflect areas for intervention. For example, our study found that neither race nor income was predictive of the discharge destination, despite the most deprived quartile having significantly more patients who self-identified as Black and having a lower mean income.…”

Section: Discussionmentioning

confidence: 99%

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Patel,

Shaikh,

Brodell

et al. 2023

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures. Methods: A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05. Results: There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay. Conclusions: Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…The therapeutical choice, of course, should take into account also several patients factors, such as: age, functional requests, comorbidities, expectative. 19 Another important aspect of our study, is that displaced proximal humeral fractures cannot be evaluated just with plain radiographs, even if performed with the trauma series views. The use of a CT-scan and of a 3D model evaluation let the surgeon knows the real position of the humeral head, the measurement of anterior or posterior head tilting, the percentage of bone loss of the calcar.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic and prognostic predictive value of the Control Volume severity grade on proximal humerus fractures due to bone fragility.

et al. 2022

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Background The treatment of proximal humerus fracture complicated by bone fragility is still controversial. The aim of this study is to compare the Neer classification and the Control Volume severity grade for the accuracy in the selection of the type of treatment and for prognostic evaluation. Materials and methods We retrospectively collected the records of all patients admitted at the Emergency Department of our Institute, from 2013 to 2020, for a closed displaced proximal humerus fracture further investigated with a CT scan before treatment decision. We selected all patients with a minimum age of 65 years. The included fractures were retrospectively classified according to Neer, and Control Volume severity grade. The included patients were evaluated with Simple Shoulder Test (SST). A statistical analysis was performed to correlate the type of treatment and the clinical results to the Neer classification and the Control Volume severity grade. Results Sixty-four patients (80%), were available for the telephonically interview at a mean follow up of 4 years and were included. According to the Control Volume model, we identified fracture with a low, medium and high severity grade, in 23 (36%), 13 (20%), and, 28 (44%) cases, respectively. Fifteen patients (23,5%) were conservatively treated, whether fourty-nine patients (76,5%) were operated. We find a statistical correlation between control volume severity grade and type of treatment. No Therapeutic correlation was detected for the Neer classification. A statistical correlation between the severity grade and clinical outcome could be observed only for patients with the same type of treatment. Conclusions The use of Control Volume severity grade is associated with better therapeutic and prognostic informations in confront to the Neer classification.

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Non-medical patient-related factor influence in proximal humeral fracture outcomes: a multicentric study

Cited by 10 publications

References 26 publications

National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Therapeutic and prognostic predictive value of the Control Volume severity grade on proximal humerus fractures due to bone fragility.

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