The Impact of Social Deprivation on Health Care Utilization Patterns Following Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures

Abstract

Background: Disparities in social determinants of health have been linked to worse patient-reported outcomes, higher postoperative pain, and increased risk of revision surgery following orthopaedic procedures. Identification of perioperative predictors of health care utilization is of particular interest to mitigate cost and improve patient outcomes. The aim of this study is to elucidate the effect of social deprivation levels, using the Area Deprivation Index (ADI), on health care utilization following the pinning of supracondylar humerus (SCH) fractures. Identifying risk factors for discrepancies in health care utilization following SCH fracture fixation can help mitigate unnecessary health care spending and improve the care of vulnerable patient populations.

Methods: This is a retrospective review of a single institution's experience with SCH fracture pinning between 2010 and 2023. Demographic variables and health care utilization data were recorded within 90 days of surgery. The ADI was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared.

Results: One thousand one hundred eighty-six patients from a single level one trauma center were included in this study. The upper, middle, and lower terciles of ADI consisted of 226, 458, and 502 patients, respectively. The most deprived tercile had greater emergency department (ED) visitation within 90 days of surgery relative to the least and intermediate-deprived terciles (incidence rate ratio [IRR] 1.85, 95% CI 1.10-3.08). Identifying as White was an independent risk factor for increased outpatient clinic utilization (IRR or 1.17, 95% CI 1.03-1.34). Higher levels of social deprivation were independent risk factors for increased ED visitation. There was no difference in 90-day inpatient readmission rates or telephone/telehealth calls made to the clinic between the least, intermediate, and most deprived patients.

Conclusions: This study begins to shed light on how social determinants of health impact the postoperative care of the pediatric orthopaedic patient and which patient populations are the most at-risk for disproportionate resource utilization after pinning of SCH fractures. Understanding these differences may lead to improved patient outcomes while decreasing potentially unnecessary burdens on the health care system.

Key concepts: (1)Social determinants of health impact the postoperative care of the pediatric patient in the setting of supracondylar humerus fractures.(2)More socially deprived patients are at higher risk of postoperative emergency department visits.(3)Patient race is shown to be a factor in postoperative clinic utilization.

Level of evidence: III, Retrospective Comparative Study.

Keywords: Closed reduction percutaneous pinning; Deprivation; Hospital readmission; Pediatric fractures; Social determinants of health; Supracondylar humerus.

Figure 1

Patient race by tercile. W, White or Caucasian; B, Black or African American; O, Other.

Figure 2

Hospital utilization by risk factor. Comprehensive forest plot displaying odds/incidence ratios stratified by predictor of the 4 parameters of hospital utilization: 90-day readmission, ED visitation, office visitation, and telephone calls. Here, patients identifying as Black were the reference group.