The role of geographic disparities in outcomes after orthopaedic trauma surgery

Thomas, Hannah M.; Jarman, Molly P.; Mortensen, Sharri J.; Cooper, Zara; Weaver, Michael J.; Harris, Mitchel B.; Ingalls, Bailey; Keudell, Arvind von

doi:10.1016/j.injury.2022.11.022

Cited by 10 publications

(5 citation statements)

References 42 publications

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“…14,25 These findings contribute to the growing body of evidence that demonstrates the significant impact of social determinants of health disparities on ankle fracture surgery, 7,8 and surgical fracture care more broadly. 9–14 However, it should be noted that rates of amputation, irrigation and debridement, and repeat ORIF were still quite low even in the homeless cohort. Therefore, until there is convincing evidence to support alternate treatment options for ankle fracture in this population, concerns regarding the risk of reoperation should not preclude surgical management in patients experiencing homelessness.…”

Section: Discussionmentioning

confidence: 99%

“…Recent findings highlight the considerable impact of social determinants of health disparities on orthopedic trauma surgery. [7][8][9][10][11][12][13] However, to our knowledge, only one study has directly explored surgical outcomes in homeless patients with orthopedic trauma. 14 Given that musculoskeletal injury is a substantial cause of disability, understanding disparities in outcomes for homeless patients following surgical fracture care may help develop interventions that promote health equity.…”

Section: Introductionmentioning

confidence: 99%

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Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Fischer,

Shahzad,

Khan

et al. 2024

OTA International

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Objectives: To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. Design: Retrospective cohort study. Setting: Mariner claims database. Patients/Participants: Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. Intervention: Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. Main Outcome Measures: One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. Results: Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08–2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08–1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00–1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59–0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63–1.18, P = 0.41). Conclusions: Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. Level of Evidence: Prognostic Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Fischer,

Shahzad,

Khan

et al. 2024

OTA International

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“…The overall role of rural-urban density in postoperative complications has been unclear, as similar nationwide studies have depicted trends that differ depending on procedure, year, and anatomical region. [35][36][37] This relationship depicts the complex interactions between socioeconomic factors that must be considered in all health disparity analyses.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sociodemographic and Hospital Factors on Inpatient Bilateral Reduction Mammaplasty: A National Inpatient Sample Analysis

Kim,

Ascherman

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Although reduction mammaplasty remains a common procedure in plastic surgery, its interaction with sociodemographic and economic disparities has remained relatively uncharacterized on a nationwide scale. Methods: Patients who underwent reduction mammaplasty were identified within the 2016–2018 National Inpatient Sample databases. In addition to clinical comorbidities, sociodemographic characteristics, hospital-level variables, and postoperative outcomes of each patient were collected for analysis. Statistical analyses, including univariate comparison and multivariate logistic regression, were applied to the cohort to determine significant predictors of adverse outcomes, described as extended length of stay, higher financial cost, and postoperative complications. Results: The final patient cohort included 414 patients who underwent inpatient reduction mammaplasty. The average age was 45.2 ± 14.5 years. The average length of stay was 1.6 ± 1.5 days, and the average hospital charge was $53,873.81 ± $36,014.50. Sixty (14.5%) patients experienced at least one postoperative complication. Black race and treatment within a nonmetropolitan or rural county predicted postoperative complications (P < 0.01). Black race, lower relative income, and concurrent abdominal contouring procedures also predicted occurrence of extended length of stay (P < 0.01). Hospital factors, including larger bed capacity and for-profit ownership, predicted high hospital charges (P < 0.05). Severity of comorbidities, measured by a clinical index, also predicted all three outcomes (P < 0.001). Conclusion: In addition to well-described clinical variables, multiple sociodemographic and economic disparities affect outcomes in inpatient reduction mammaplasty.

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Section: Discussionmentioning

confidence: 99%

“…31 Several orthopaedic studies have demonstrated that Medicaid/Medicare insurance status limits access to orthopaedic spine care, physical therapy, 32 outpatient orthopaedic care, 33 and tertiary hand surgery referral centers 34 and is associated with increased mortality in orthopaedic trauma surgery. 35 Interestingly, the results of this study demonstrate that Black race was not an independent predictor of survival compared with White race when other clinical covariates were accounted for (aHR, 1.02; 95% CI, 0.93 to 1.11; P = 0.72), but Asian American Pacific Islander race was associated with significantly improved survival compared with White race (aHR, 0.77; 95% CI, 0.76 to 0.79; P , 0.0001). This finding contradicts previous studies that have shown worse outcomes associated with non-White race.…”

Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

Mani,

Kleinbart,

Schlumprecht

et al. 2024

J Am Acad Orthop Surg

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Background: The effect of socioeconomic status (SES) on the outcomes of patients with metastatic cancer to bone has not been adequately studied. We analyzed the association between the Yost Index, a composite geocoded SES score, and overall survival among patients who underwent nonprimary surgical resection for bone metastases. Methods: This population-based study used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results database (2010 to 2018). We categorized bone and joint sites using International Classification of Disease-O-3 recodes. The Yost Index was geocoded using a factor analysis and categorized into quintiles using census tract–level American Community Service 5-year estimates and seven measures: median household income, median house value, median rent, percent below 150% of the poverty line, education index, percent working class, and percent unemployed. Multivariate Cox regression models were used to calculate adjusted hazard ratios of overall survival and 95% confidence intervals. Results: A total of 138,158 patients were included. Patients with the lowest SES had 34% higher risk of mortality compared with those with the highest SES (adjusted hazard ratio of 1.34, 95% confidence interval: 1.32 to 1.37, P < 0.001). Among patients who underwent nonprimary surgery of the distant bone tumor (n = 11,984), the age-adjusted mortality rate was 31.3% higher in the lowest SES patients compared with the highest SES patients (9.9 versus 6.8 per 100,000, P < 0.001). Patients in the lowest SES group showed more racial heterogeneity (63.0% White, 33.5% Black, 3.1% AAPI) compared with the highest SES group (83.9% White, 4.0% Black, 11.8% AAPI, P < 0.001). Higher SES patients are more likely to be married (77.5% versus 59.0%, P < 0.0001) and to live in metropolitan areas (99.6% versus 73.6%, P < 0.0001) compared with lower SES patients. Discussion: Our results may have implications for developing interventions to improve access and quality of care for patients from lower SES backgrounds, ultimately reducing disparities in orthopaedic surgery.

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The role of geographic disparities in outcomes after orthopaedic trauma surgery

Cited by 10 publications

References 42 publications

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Impact of Sociodemographic and Hospital Factors on Inpatient Bilateral Reduction Mammaplasty: A National Inpatient Sample Analysis

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

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